Document Detail

Optimal atrioventricular delay in CRT patients can be approximated using surface electrocardiography and device electrograms.
MedLine Citation:
PMID:  20522154     Owner:  NLM     Status:  In-Process    
BACKGROUND: Optimization of the atrioventricular (AV) delay (AVD) may result in an improvement in cardiac resynchronization therapy (CRT) outcome. Previous studies have shown positive correlation between interatrial conduction time measured invasively during the implant procedure and optimal AVD determined postimplant using Doppler echocardiography. We hypothesized that the optimal AVD can be predicted noninvasively from surface electrocardiogram (ECG).
METHODS: The optimal sensed (SAV) and paced (PAV) AVDs were determined for CRT patients (n = 63) by programming different AVDs (in 20 ms steps, in random sequence) and evaluating Doppler images of the mitral flow (iterative method). The time intervals between atrial sensing (As) and pacing (Ap) to the end of the P-wave (Pend) and to the right ventricular sensing (RVs) were measured from 5 ECG leads (limb, V1, and V3) and device telemetry during sinus rhythm and atrial pacing.
RESULTS: Optimal SAV was 120 ± 30 ms and correlated with As-Pend (R = 0.69, P < 0.0001) and As-RVs (R = 0.45, P = 0.0003). Optimal PAV was 172 ± 38 ms and correlated with Ap-Pend (R = 0.65, P < 0.0001) and Ap-RVs (R = 0.60, P < 0.0001). Regression analysis suggested a simple method of AVD adjustment by pacing the ventricles 40 ms after the end of the sensed P-wave or 30 ms after the end of the paced P-wave but not at the expense of biventricular capture. Such a method would have resulted in significantly lower deviation from echo-optimal AVDs compared with programming fixed values.
CONCLUSION: A simple method of providing 30-40 ms separation between the end of the P-wave and ventricular pacing pulse can be used to approximate echocardiographically optimal AV delays.
R Christopher Jones; Tom Svinarich; Andrew Rubin; Vadim Levin; Robert Phang; Jaime Murillo; Aleksandre Sambelashvili
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of cardiovascular electrophysiology     Volume:  21     ISSN:  1540-8167     ISO Abbreviation:  J. Cardiovasc. Electrophysiol.     Publication Date:  2010 Nov 
Date Detail:
Created Date:  2010-11-02     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9010756     Medline TA:  J Cardiovasc Electrophysiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1226-32     Citation Subset:  IM    
Copyright Information:
© 2010 Wiley Periodicals, Inc.
Centennial Heart Cardiovascular Associates, Nashville, Tennessee, USA.
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