Document Detail


Iterative cardiac output measurement for optimizing cardiac resynchronization therapy: a randomized, blinded, crossover study.
MedLine Citation:
PMID:  20663072     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Many invasive and noninvasive methods have been proposed for guiding optimal programming of cardiac resynchronization therapy (CRT) devices. However, results are not satisfying. Preliminary results suggest that cardiac output (CO) measurements using inert gas rebreathing (IGR) might be an eligible method to tailor atrioventricular (AV) and ventriculo-ventricular (VV) programming. The aims of the present study were: (1) to evaluate whether an optimization of CRT can be obtained by noninvasive CO measurements and (2) to evaluate whether acute hemodynamic improvements obtained by this approach relate into increase in cardiac exercise capacity.
METHODS: In 24 patients on CRT, iterative VV- and AV-delay optimization was done using the IGR method. This blinded, randomized, crossover study compared the responses to optimization during two periods: a 4-week optimized and a 4-week standard programming. Exercise capacity after optimization was assessed after each period by New York Heart Association (NYHA) classification, a 6-minute walking test, and quality of life (QoL) questionnaire.
RESULTS: CO could be determined by IGR in all patients. The NYHA class decreased by 17.8% (2.8 ± 0.3 vs 2.3 ± 0.4, P < 0.001), the mean (± standard deviation) distance walked in 6 minutes was 9.3% greater after optimization (456 ± 140 m vs 417 ± 134 m, P < 0.001), and the QoL improved by 14.5% (41.8 ± 10.4 vs 36.5 ± 9.5, P < 0.001). The portion of responders to CRT increased from 66.5% to 87.5%.
CONCLUSION: CRT optimization by iterative CO measurements leads to an increase in CO and an improvement of exercise capacity. Our results suggest that this method might become an important additive tool to adjust CRT programming.
Authors:
Nico Reinsch; Thomas Konorza; Dagmar Woydowski; Heike Bruck; Michaela Volsek; Thomas Müller-Tasch; Till Neumann; Raimund Erbel; Heinrich Wieneke
Publication Detail:
Type:  Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  Pacing and clinical electrophysiology : PACE     Volume:  33     ISSN:  1540-8159     ISO Abbreviation:  Pacing Clin Electrophysiol     Publication Date:  2010 Oct 
Date Detail:
Created Date:  2010-09-30     Completed Date:  2011-02-01     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7803944     Medline TA:  Pacing Clin Electrophysiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1188-94     Citation Subset:  IM    
Copyright Information:
©2010, The Authors. Journal compilation ©2010 Wiley Periodicals, Inc.
Affiliation:
West-German Heart Centre Essen, Department of Cardiology, University of Duisburg-Essen, Hufelandstrasse 55, Essen, Germany. nico.reinsch@uk-essen.de
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MeSH Terms
Descriptor/Qualifier:
Aged
Cardiac Output*
Cardiac Resynchronization Therapy / methods*
Cardiac Resynchronization Therapy Devices*
Cross-Over Studies
Exercise
Female
Humans
Male
Middle Aged
Quality of Life
Stroke Volume
Walking

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


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