Key result
Adjusting the atrioventricular delay 40 ms below or above its peak value significantly reduced relative systolic blood pressure by 4.9 mmHg (P<0.003) and 4.4 mmHg (P<0.0005), respectively.
Why the study?
Does adjustment of atrioventricular delay using continuous non-invasive blood pressure monitoring optimize hemodynamic response in patients with cardiac resynchronization therapy?
Observational (n=12)
Does adjustment of atrioventricular delay using continuous non-invasive blood pressure monitoring optimize hemodynamic response in patients with cardiac resynchronization therapy?
Continuous non-invasive arterial pressure monitoring can identify an individualized, highly reproducible optimal AV delay in CRT patients, which has significant hemodynamic effects, especially at higher heart rates.
AV delay optimization via noninvasive BP monitoring may enhance hemodynamics in CRT; hypothesis-generating and should not yet change practice.
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.
No takes yet. Share an insight, caveat, or question.
Whinnett et al. (2006) conducted an observational in Cardiac resynchronization therapy (n=12). Atrioventricular delay adjustment vs. Reference AV delay of 120 ms was evaluated on Systolic blood pressure relative to a reference AV delay of 120 ms (SBPrel) (p=<0.0001). Adjusting the atrioventricular delay 40 ms below or above its peak value significantly reduced relative systolic blood pressure by 4.9 mmHg (P<0.003) and 4.4 mmHg (P<0.0005), respectively.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:
More on Heart failureMore from EP Europace