June 18, 2010EP Europace
Can optimization of pacing settings compensate for a non-optimal left ventricular pacing site?
Key result
Optimization of atrioventricular and interventricular delays at a non-optimal left ventricular pacing site improved dP/dt(max) by 6.5 percentage points (95% CI 1.2-13.9; P=0.001).
Why the study?
Does optimization of atrioventricular and interventricular delay improve acute haemodynamic response in heart failure patients with a non-optimal LV pacing site?
Population
16 patients with heart failure, median QRS duration of 172 ms, and median LV ejection fraction of 20%
Comparison
Optimization of pacing settings during… vs Biventricular pacing with nominal settings at a…
Design
Cohort
Follow-up
acute
Authors
Discussion
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Implication
Delay optimization may partially offset non-optimal LV sites acutely; hypothesis-generating for long-term CRT outcomes.
Structured PICO
Does optimization of atrioventricular and interventricular delay improve acute haemodynamic response in heart failure patients with a non-optimal LV pacing site?
P
Population
16 patients with heart failure (NYHA class III or IV, median QRS duration 172 ms, median LVEF 20%) undergoing assessment of acute haemodynamic effects of biventricular pacing.
I
Intervention
Optimization of pacing settings (atrioventricular delay [AVD] and interventricular delay [VVD]) during biventricular pacing at a non-optimal LV pacing site
C
Comparator
Biventricular pacing with nominal settings at a non-optimal LV pacing site
O
Outcome
Acute haemodynamic effect assessed by the increase in maximum rate of left ventricular pressure rise (%dP/dt(max))surrogate
Main Result
Mean Difference: 6.5 (95% CI 1.2–13.9)
p-value: p=0.001
Optimization of AV and VV delays can partially compensate for a non-optimal LV pacing site in CRT, although combining an optimal site with optimized settings yields the best acute haemodynamic response.
Cite This Study
Bogaard et al. (2010) studied Heart failure (n=16). Optimization of pacing settings (atrioventricular and interventricular delay) vs. Nominal pacing settings at a non-optimal LV pacing site was evaluated on Increase in maximum rate of LV pressure rise (%dP/dt(max)) (MD 6.5 percentage points, 95% CI 1.2-13.9, p=0.001). Optimization of atrioventricular and interventricular delays at a non-optimal left ventricular pacing site improved dP/dt(max) by 6.5 percentage points (95% CI 1.2-13.9; P=0.001).