Key result
Optimal AV delay in biventricular pacing increases systolic blood pressure by ~1 mmHg vs fixed delay.
Why the study?
It is not known whether the optimal atrioventricular delay varies between left ventricular pacing sites during endocardial biventricular pacing.
Does hemodynamic AV optimization during endocardial biventricular pacing improve systolic blood pressure compared to a fixed AV delay across different LV lead locations in patients with heart failure?
Does hemodynamic AV optimization during endocardial biventricular pacing improve systolic blood pressure compared to a fixed AV delay across different LV lead locations in patients with heart failure?
Answers are grounded in this paper and cite their sources.
AV optimization improves acute hemodynamics slightly more than a fixed AV delay during endocardial biventricular pacing, but applying the optimum from one LV location to another has very small hemodynamic consequences.
Introduction It is not known whether the optimal atrioventricular (AV opt ) delay varies between left ventricular (LV) pacing site during endocardial biventricular pacing (BiVP) and may therefore needs consideration. Methods We assessed the hemodynamic AV opt in patients with chronic heart failure undergoing endocardial LV lead implantation. AV opt was assessed during atrio‐BiVP with a “roving LV lead.” Up to four locations were studied: mid‐lateral wall, mid‐septum (or a close alternative), site of greatest hemodynamic improvement, and LV lead implant site. The AV opt was compared to a fixed AV delay of 180 ms. Results Seventeen patients were included (12 male, aged 66.5 ± 12.8 years, ejection fraction 26 ± 7%, 16 left bundle branch block or high percentage of right ventricular pacing [RVP], QRS duration 167 ± 27 ms). In most locations (62/63), AV opt increased systolic blood pressure during BiVP compared with RVP (relative improvement 6 mmHg, interquartile range [IQR] 4–9 mmHg). Compared to a fixed AV delay, the hemodynamic improvement at AV opt was higher (1 mmHg, IQR 0.2–2.6 mmHg, p < .001). Within most patients (16/17), we observed a difference in AV opt between pacing sites (median paced AV opt 209 ms, IQR 117–250). Within this range, the hemodynamic impact of these differences was small (median loss 0.6 mmHg, IQR 0.1–2.6 mmHg). Conclusion Within a patient, different endocardial LV lead locations have slightly different hemodynamic AV opt which are superior to a fixed AV delay. The hemodynamic consequence of applying an optimum from a different lead location is small.
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Butcher et al. (2023) studied chronic heart failure with conventional indications for cardiac resynchronization therapy (n=17). Biventricular pacing at optimal atrioventricular delay (AVopt) vs. Biventricular pacing at a fixed atrioventricular delay of 180 ms was evaluated on Improvement in systolic blood pressure compared to right ventricular pacing (MD 1 mmHg (IQR 0.2-2.6 mmHg), p=<.001). Biventricular pacing at the optimal atrioventricular delay significantly improved systolic blood pressure by a median of 1 mmHg compared to a fixed AV delay of 180 ms.
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