Document Detail


Determination of optimal atrioventricular delay for cardiac resynchronization therapy using acute non-invasive blood pressure.
MedLine Citation:
PMID:  16635996     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
AIMS: In this study, we apply non-invasive blood pressure (BP) monitoring, by continuous finger photoplethysmography (Finometer), to detect directly haemodynamic responses during adjustment of the atrioventricular (AV) delay of cardiac resynchronization therapy (CRT), at different heart rates. METHODS AND RESULTS: Twelve patients were studied with six re-attending for reproducibility assessment. At each AV delay, systolic BP relative to a reference AV delay of 120 ms (SBPrel) was calculated. We found that at higher heart rates, altering the AV delay had a more pronounced effect on BP (average range of SBPrel=17.4 mmHg) compared with resting rates (average range of SBPrel=6.5 mmHg), P<0.0001. Secondly, peak AV delay differed between patients (minimum 120 ms, maximum 200 ms). Thirdly, small changes in AV delay had significant BP effects: programming AV delay 40 ms below the peak AV delay reduced SBPrel by 4.9 mmHg (P<0.003); having it 40 ms above the peak decreased SBPrel by 4.4 mmHg (P<0.0005). Finally, the peak AV delay is highly reproducible both on the same day and at 3 months (Bland-Altman difference: 3+/-8 ms). CONCLUSIONS: Continuous non-invasive arterial pressure monitoring demonstrates that even small changes in AV delay from its haemodynamic peak value have a significant effect on BP. This peak varies between individuals, is highly reproducible, and is more pronounced at higher heart rates than resting rates.
Authors:
Zachary I Whinnett; Justin E R Davies; Keith Willson; Anthony W Chow; Rodney A Foale; D Wyn Davies; Alun D Hughes; Darrel P Francis; Jamil Mayet
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology     Volume:  8     ISSN:  1099-5129     ISO Abbreviation:  Europace     Publication Date:  2006 May 
Date Detail:
Created Date:  2006-04-25     Completed Date:  2006-10-20     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  100883649     Medline TA:  Europace     Country:  England    
Other Details:
Languages:  eng     Pagination:  358-66     Citation Subset:  IM    
Affiliation:
International Centre for Circulatory Health, National Heart and Lung Institute, St Mary's Hospital and Imperial College, 5, 9-61 North Wharf Road, London W2 1LA, UK. zacharywhinnett@yahoo.com
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Analysis of Variance
Atrioventricular Node / physiopathology*
Blood Pressure / physiology*
Bundle-Branch Block / physiopathology,  therapy*
Cardiac Pacing, Artificial / methods*
Echocardiography
Female
Heart Failure / physiopathology,  therapy*
Heart Rate / physiology
Humans
Male
Middle Aged
Reproducibility of Results
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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