Key result
Electrogram-guided AV optimization links to ~1.5 cm higher aortic VTI vs ventricular synchrony alone.
Why the study?
Strategies to optimize AV delay in CRT based on optimal AV synchrony versus ventricular synchrony can be discordant, prompting exploration of a new electrogram-guided optimization algorithm.
Can an electrogram-guided AV delay optimization algorithm estimate the optimal AV delay for maximal integrative atrioventricular and ventricular resynchronization in patients with CRT?
Observational (n=49)
Yes
Can an electrogram-guided AV delay optimization algorithm estimate the optimal AV delay for maximal integrative atrioventricular and ventricular resynchronization in patients with CRT?
p-value: p=<0.001
An electrogram-guided AV delay optimization algorithm can estimate the optimal AV delay for maximal integrative atrioventricular and ventricular resynchronization in CRT patients.
May support electrogram-guided AV optimization in CRT; hypothesis-generating and requires randomized outcome trials before practice change.
Background Atrioventricular (AV) delay could affect AV and ventricular synchrony in cardiac resynchronization therapy (CRT). Strategies to optimize AV delay according to optimal AV synchrony (AV opt-AV ) or ventricular synchrony (AV opt-V ) would potentially be discordant. This study aimed to explore a new AV delay optimization algorithm guided by electrograms to obtain the maximum integrative effects of AV and ventricular resynchronization (opt-AV). Methods Forty-nine patients with CRT were enrolled. AV opt-AV was measured through the Ritter method. AV opt-V was obtained by yielding the narrowest QRS. The opt-AV was considered to be AV opt-AV or AV opt-V when their difference was < 20 ms, and to be the AV delay with the maximal aortic velocity–time integral between AV opt-AV and AV opt-V when their difference was > 20 ms. Results The results showed that sensing/pacing AV opt-AV (SAV opt-AV /PAV opt-AV ) were correlated with atrial activation time (P end-As /P end-Ap ) ( P < 0.05). Sensing/pacing AV opt-V (SAV opt-V /PAV opt-V ) was correlated with the intrinsic AV conduction time (As-Vs/Ap-Vs) ( P < 0.01). The percentages of patients with more than 20 ms differences between SAV opt-AV /PAV opt-AV and SAV opt-V /PAV opt-V were 62.9% and 57.1%, respectively. Among them, opt-AV was linearly correlated with SAV opt-AV /PAV opt-AV and SAV opt-V /PAV opt-V. The sensing opt-AV (opt-SAV) = 0.1 × SAV opt-AV + 0.4 × SAV opt-V + 70 ms (R 2 = 0.665, P < 0.01) and the pacing opt-AV (opt-PAV) = 0.25 × PAV opt-AV + 0.5 × PAV opt-V + 30 ms (R 2 = 0.560, P < 0.01). Conclusion The SAV opt-AV /PAV opt-AV and SAV opt-V /PAV opt-V were correlated with the atrial activation time and the intrinsic AV conduction interval respectively. Almost half of the patients had a > 20 ms difference between SAV opt-AV /PAV opt-AV and SAV opt-V /PAV opt-V . The opt-AV could be estimated based on electrogram parameters.
No takes yet. Share an insight, caveat, or question.
Li et al. (2021) conducted an observational in Heart failure with cardiac resynchronization therapy (n=49). Electrographic AV optimization algorithm (opt-AV) vs. AV delay optimized for ventricular synchrony (AVopt-V) or AV synchrony (AVopt-AV) was evaluated on Aortic velocity-time integral (AoVTI) difference between opt-SAV and SAVopt-V (p=<0.001). An electrogram-guided atrioventricular delay optimization algorithm significantly improved hemodynamics compared to optimization based solely on ventricular synchrony, increasing the aortic velocity-time integral by a mean of 1.52 cm.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: