AV and VV delay optimization provides acute hemodynamic improvement but limited long-term clinical benefit compared to empiric AV delay in patients receiving cardiac resynchronization therapy.
Does AV and VV delay optimization improve long-term clinical benefit compared to empiric programming in patients receiving CRT?
Routine AV and VV optimization for CRT offers limited long-term clinical benefit over empiric programming, though it may have a role in non-responders.
Abstract Cardiac resynchronization therapy is an effective therapy for patients with left ventricular systolic dysfunction and a ventricular conduction delay; however, approximately 30% of patients do not experience significant clinical improvement with this treatment. Modern devices allow individualized programming of the AV delay and VV offset, which offer the possibility of improving clinical response rates with optimized programming. AV and VV delay optimization techniques have included echocardiography, device‐based algorithms, and several other novel noninvasive techniques. While an acute improvement in hemodynamic function has been clearly demonstrated with optimized device settings, long‐term clinical benefit is limited. In the majority of cases, an empiric AV delay with simultaneous biventricular or left ventricular pacing is adequate. The value of optimization of these intervals in “non‐responders” still requires further investigation.
Brabham et al. (Sat,) conducted a review in Left ventricular systolic dysfunction and ventricular conduction delay. AV and VV delay optimization vs. Empiric AV delay with simultaneous biventricular or left ventricular pacing was evaluated. AV and VV delay optimization provides acute hemodynamic improvement but limited long-term clinical benefit compared to empiric AV delay in patients receiving cardiac resynchronization therapy.
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