Echocardiographic atrioventricular interval optimization in patients with dual-chamber pacemakers and symptomatic left ventricular systolic dysfunction (original) (raw)
Related papers
Pacing and Clinical Electrophysiology, 1996
MODENA, M.G., ET AL.; The Importance of Different Atrioventricular Delay for Left Ventricular Eilling in Sequential Pacing: Clinical Implications. We assessed the influence and clinical consequences of different AV delay on ventricular filling in 30 patients (mean age 60 ± 5 years) who had DDD pacemakers for AV hlock. All 30 patients presented a normal ejection fraction, but in 18 cases (Group I), an echo-Doppler examination revealed ventricular hypertrophy (mean end-diastolic wall thickness of 1.4 ±0.16 cm. LV mass index 155 ± 17g/m^). and an abnormal relaxation pattern (isovolumetric relaxation time = 124.72 ± 11.82; early to late peak velocity = 0.6 ± 0.03: deceleration time = 296.83 ± 34.02 ms). Group II included the remaining 12 patients who had a normal filling pattern. In all 30 patients, the pattern was reassessed following modification of the AV delay (200. 150, 100, and 75 ms). Patients at baseline (AV delay of 200 ms) also underwent an exercise test with determination of respiratory gas exchange. In Group I, 13 (72.5%) patients were classified as Weber class B (VO2 Max 16.8 ± 1.7mL/min per kg): and 5 (27.5%) were Glass A (VO2 Max 22.5 ±1.4
Optimal Atrioventricular Delay in Physiological Pacing Determined by Doppler Echocardiography
Pacing and Clinical Electrophysiology, 1986
FORFANG, K., ET AL.: Optimal atrioventricular delay in physiological pacing determined by Doppler echocardiography. Our study incJuded eight patients with physiological pacemakers programmed to the VDD mode. The blood velocity in the aortic root was determined by Doppler echocardiography. Changes in the integral of maximum velocity reflect stroke volume changes. The Doppler probe was placed and heJd in the suprasternai position whiJe programming the pacemcii<ers from the WI to all available AV delays in the VDD mode; the heart rates were nearly constant. Stroke volumes were highly dependent on changes of the AV delay; the optimum AV delay varied considerably from patient to patient. These changes were more pronounced in the patients with lefl ventricular strain due to aortic valve disease than in the patients with isolated conduction defects. (PACE, Vol 9, /anuary-February, 1986) atrioventricuJar delay, Doppier echocardiography, physiological pacing Address for reprints; Kolbjarn Forfang. M.D., Medical Department B,
Optimization of atrio-ventricular delay in patients with dual-chamber pacemaker
International Journal of Cardiology, 2010
Development and advances in heart pacing over the last nearly half a century allowed to save numerous lives by providing pacing support in bradycardia and complete heart block. Nevertheless, long-term follow up of patients with implanted pacemaker showed unfavorable remodeling of the heart, both from hemodynamic as well as electrical standpoint. The optimal programmed pacemaker setting, apart from the optimal place for ventricular stimulation, is essential to obtain the best hemodynamic and the clinical after-effects of the stimulation of the heart and to minimize potential unfavorable effects. In patients with dual-chamber pacemaker (DDD) the correct function of the left ventricle of the heart depends mainly on the electric delays between the stimulated chambers. Atrio-ventricular delay (AVD) during dual-chamber pacing influences left ventricle contraction function through preload modulation. Improperly programmed AVD in the DDD pacemaker can have unfavorable hemodynamic results. Various methods have been developed during last few decades (right heart catheterization, ventriculography, peak endocardial acceleration, echocardiography, and impedance cardiography), however only echocardiography and reocardiography are currently in general use. There should be noticed too, that also the application of special algorithms present in modern pacemakers allowing for dynamic changes of the time of the delay represents certain alternative to individual AVD optimization.
Kardiologia Polska, 2014
Background: Optimisation of atrioventricular (AV) delay time has positive effects on left ventricular (LV) functions in patients with a DDD pacemaker. However, the method used for optimisation is still debated. Aim: To evaluate the effect of different AV delay times on various LV systolic performances by using automated functional imaging (AFI) in patients with a DDD pacemaker and preserved LV systolic function. Methods: The study population consisted of 40 patients with a DDD pacemaker implanted for third degree AV block and preserved LV systolic function (19 men; mean age 64.3 ± 10.9 years). During each pacing period, blood samples were taken for the measurement of B-type natriuretic peptide (BNP) levels, and telemetric and echocardiographic evaluations were performed to all patients. Also peak systolic global longitudinal strain (PSGLS) was calculated using the AFI method. Results: No significant differences except for LV outflow tract-velocity time integral (LVOT-VTI) were observed in pulse wave Doppler parameters with different AV delay times. PSGLS were better at 150 and 200 ms AV delay times compared to 100 ms (p < 0.001 for 100-150 ms and 100-200 ms). Similarly, LVOT-VTI values were significantly higher at 150 and 200 ms AV delay times compared to 100 ms (for 100-150 ms, p = 0.017 and for 100-200 ms, p = 0.013). Also there was a significant reduction in BNP levels at 150 ms and 200 ms compared to 100 ms AV delay time (for 100-150 ms, p = 0.001, and for 100-200 ms, p < 0.001). Conclusions: In patients with an implanted DDD pacemaker and preserved LV systolic function, increasing AV delay time has beneficial effects on LV systolic performance in the acute phase, as shown by the AFI method in our study.
A Perspective on Atrioventricular Delay Optimization in Patients with a Dual Chamber Pacemaker
Pacing and Clinical Electrophysiology, 2004
PORCIANI, M.C., ET AL.: A Perspective on Atrioventricular Delay Optimization in Patients with a Dual Chamber Pacemaker. Atrioventricular delay (AVD) is critical in patients with DDD pacemakers (PM). Echo/Doppler evaluation of AVD providing the longest left ventricular filling time (FT) or the highest cardiac output (CO) is used for AVD optimization. Recently myocardial performance index (MPI) has been shown to improve by optimizing AVD. The aim was to compare the CO, FT, MPI derived optimal AVD, and to analyze systolic and diastolic performance at every optimal AVD. Twenty-five patients, 16 men 68 ± 11 years, ejection fraction ≥ 50%, with a DDD PM for third-degree AV block, without other major cardiomyopathies, underwent echo/Doppler AVD optimization. CO, FT, and MPI derived optimal AVDs were identified as the AVDs providing the highest CO, the longest FT, and the minimum MPI, respectively.
Russian Journal of Cardiology, 2014
Cardiac resynchronization therapy (CRT) improves ventricular dyssynchrony and is associated with an improvement in life quality and prognosis. Aim. The aim of study was to examine acute hemodynamic changes with different of CRT device modalities throughout optimization procedure and its impact on one year prognosis. Material and methods. The study comprised 62 patients with severe left ventricular systolic dysfunction (LVEF 24,6±4,4%, QRS duration 154,71±14,92 ms, NYHA class III/IV 47/15) with implanted CRT device. After implantation and before discharge all the patients underwent optimization procedure guided by Doppler echocardiography. Left (LVPEI) and right (RVPEI) ventricular pre-ejection intervals, interventricular mechanical delay (IVD) and the maximal rate of ventricular pressure rise during early systole (max dP/dt) were measured during left and biventricular pacing with three different atrioventricular (AV) delays. Stroke volume derived from the left ventricular outflow tract velocity-time integral (VTI) of left ventricular outflow tract (LVOT VTI) was measured as well. After one year patients underwent clinical, echocardiographical examination and 6 minute walking test. Results. After CRT device optimization, optimal AV delay and CRT mode were defined. Left ventricular pre-ejection intervals changed from 175,4±21,5 to 142,6±16,7 (p < 0,01), RVPEI from 108,6±18,9 to 127,3±18,3 (p < 0,001), IVD from 71,3±14,8 to 24,7±7,6 (p < 0,001) and dP/dt from 532,2±74 to 675,2±111 (p < 0,001). Left ventricular outflow tract VTI increased after optimization procedure from 18±3,4 to 21±1,5 cm (p<0,05). Conclusions. Echocardiographic optimization procedure emphasizes the individualized approach in CRT optimization procedure in order to derive the best short and long term results.
Circulation, 1999
Background —Previous studies of pacing therapy for dilated congestive heart failure (CHF) have not established the relative importance of pacing site, AV delay, and patient heterogeneity on outcome. These variables were compared by a novel technique that evaluated immediate changes in hemodynamic function during brief periods of atrial-synchronous ventricular pacing. Methods and Results —Twenty-seven CHF patients with severe left ventricular (LV) systolic dysfunction and LV conduction disorder were implanted with endocardial pacing leads in the right atrium and right ventricle (RV) and an epicardial lead on the LV and instrumented with micromanometer catheters in the LV, aorta, and RV. Patients in normal sinus rhythm were stimulated in the RV, LV, or both ventricles simultaneously (BV) at preselected AV delays in a repeating 5-paced/15-nonpaced beat sequence. Maximum LV pressure derivative (LV+dP/dt) and aortic pulse pressure (PP) changed immediately at pacing onset, increasing at a...
Journal of the American College of Cardiology, 1995
Objectives. This prospective study assessed the initial hemodynamic effects and long-term clinical benefits of dual-chamber pacing with a short atrioventricular (AV) delay in patients with chronic heart failure who had no traditional indication for pacemaker implantation. Background. Dual-chamber pacing with a short AV delay has been proposed as a nonpharmacologic treatment for drugrefractory heart failure. Both initial and long-term hemodynamic as well as functional benefits have been reported. All previous studies have used an AV delay of 100 ms. Despite encouraging results, these previous studies have been anecdotal and uncontrolled. Methods. This double-blind, randomized, crossover trial included 12 subjects with chronic congestive heart failure despite optimal medical therapy. Patients were required to be in sinus rhythm with no evidence of significant bradyarrhythmias. On the day after implantation of a dual-chamber pacemaker, invasive hemodynamic measurements were made at varying AV delays between 100 and 200 ms. Patients were then randomized to either dual-chamber pacing with a 100-ms AV delay or backup mode (VVI at 40 beats/rain). After 4 to 6 weeks, crossover to the other pacing mode was programmed. Results. Hemodynamic measurements on the day after pacemaker implantation demonstrated no benefit of pacing with any AV delay compared with intrinsic conduction. At the optimal AV interval for each patient, neither cardiac output (4.5-+ 1.5 vs. 4.7-+ 1.6 liters/rain [mean-+ SD]) nor wedge pressure (16-+ 10 vs. 17-+ 8 mm Hg) improved significantly from baseline measurements during intrinsic conduction. The long-term pacing protocol was completed in nine patients. Ejection fraction was 16-+ 6% with dual.chamber (VDD mode) pacing and 18-+ 4% in backup mode (p = NS). No patient had an increase in ejection fraction by >5% with VI)D pacing, nor did any patient improve in New York Heart Association functional class with short AV delay dual-chamber pacing. Also, there were no significant reductions in body weight or diuretic requirements during this pacing period. Conclusions. Dual-chamber pacing with a short AV delay does not improve hemodynamic and clinical status or ejection fraction measured on the day after pacemaker implantation in patients with chronic congestive heart failure. Routine use of pacemaker therapy with a short AV delay as a primary treatment of heart failure in patients without standard arrhythmic indications is unwarranted.