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September 28, 2020International Heart JournalOpen Access

The Usefulness and Limitations of Impedance Cardiography for Cardiac Resynchronization Therapy Device Optimization

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Key result

Impedance cardiography yields an 18-ms shorter optimal AV delay than echocardiography, with mismatch predicted by postoperative MR.

  • P=0.018
  • n=42

Why the study?

Optimizing AV and VV delays improves CRT outcomes, but UCG optimization requires high technical expertise; impedance cardiography may offer an alternative.

Does impedance cardiography provide similar atrioventricular and interventricular delay optimization compared to ultrasonic echocardiography in patients with CRT devices?

Comparison

Optimization with ICG vs UCG

Design

Retrospective analysis

Follow-up

1 week after implantation

Authors

KOKojiro OgawaMIMiyako IgarashiANAkihiko Nogami

Discussion

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Overview

ICG should not yet replace echocardiography for CRT AV optimization with postoperative MR; leaves open validation in larger prospective cohorts without MR.

Study Design

Type

Observational (n=42)

Structured PICO

Does impedance cardiography provide similar atrioventricular and interventricular delay optimization compared to ultrasonic echocardiography in patients with CRT devices?

P
Population
42 patients with heart failure (NYHA class II-IV, LVEF < 35%, QRS duration >= 120 ms) who underwent successful implantation of a cardiac resynchronization therapy (CRT) device. Mean age 68, 67% male. Excluded: persistent atrial fibrillation, high burden of ventricular premature beats (>= 10%), hemodialysis, and failing to carry out optimization with ICG.
I
Intervention
Optimization of atrioventricular (AV) and interventricular (VV) delay using Impedance Cardiography (ICG) performed 1 week after implantation.
C
Comparator
Optimization of atrioventricular (AV) and interventricular (VV) delay using Ultrasonic Echocardiography (UCG) performed 1 week after implantation.
O
Outcome
Difference in optimized AV delay (AVD) and VV delay (VVD) between ICG and UCG methods.surrogate

Main Result

Absolute Event Rate: 128% vs 146%

p-value: p=0.018

Impedance cardiography is a rapid, noninvasive tool for CRT optimization that yields shorter AV delays than echocardiography, but it may be unreliable in patients with moderate-to-severe mitral regurgitation.

Limitations

  • In patients with moderate-to-severe mitral regurgitation, ICG may not be able to optimize AVD.
  • Cannot make inferences regarding prognosis
  • ICG cannot detect diastolic mitral regurgitation
  • Approximations and assumptions in ICG-guided stroke volume estimation

Cite This Study

Ogawa et al. (2020) conducted an observational in Cardiac resynchronization therapy (CRT) (n=42). Impedance cardiography (ICG) vs. Ultrasonic echocardiography (UCG) was evaluated on Optimized atrioventricular delay (AVD) in milliseconds (p=0.018). Impedance cardiography yielded a significantly shorter optimal AV delay than echocardiography (128 vs 146 ms, P=0.018), with postoperative mitral regurgitation predicting mismatch between the methods.

synapsesocial.com/papers/6a13dc7bf88db7183c5981f2https://doi.org/10.1536/ihj.19-620
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Impedance cardiography: a useful and reliable tool in optimization of cardiac resynchronization devices2007 · 55 citations
  2. 2Acute Evaluation of Programmer‐Guided AV/PV and VV Delay Optimization Comparing an IEGM Method and Echocardiogram for Cardiac Resynchronization Therapy in Heart Failure Patients and Dual‐Chamber ICD Implants2006 · 109 citations
  3. 3Comparison of quick optimization of interventricular delay between simple methods: intracardiac electrogram and surface electrocardiogram after cardiac resynchronization therapy2012 · 11 citations
  4. 4Cardiac resynchronization therapy during rest and exercise: comparison of two optimization methods2008 · 39 citations
  5. 5Optimization of Cardiac Resynchronization Therapy: Echocardiographic vs Semiautomatic Device Algorithms2009 · 12 citations