Cardiac resynchronization therapy during rest and exercise: comparison of two optimization methods
Key result
Exercise optimization of VV delay improved intraventricular dyssynchrony and increased aortic velocity time integral compared with the resting setting (P<0.001).
Why the study?
Does CRT optimization during exercise improve haemodynamic parameters compared to resting optimization in heart failure patients with CRT defibrillators?
Population
24 heart failure patients previously implanted with a CRT defibrillator
Comparison
Atrioventricular and interventricular delay… vs AV and VV delay optimization at rest
Design
Cohort
Authors
Discussion
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Implication
Optimal VV delay varies with exercise in many CRT patients while AV delay is stable; leaves open whether exercise-based optimization improves outcomes.
Structured PICO
Does CRT optimization during exercise improve haemodynamic parameters compared to resting optimization in heart failure patients with CRT defibrillators?
P
Population
24 heart failure patients previously implanted with a CRT defibrillator who underwent AV and VV delay optimization at rest and during exercise.
I
Intervention
Atrioventricular (AV) and interventricular (VV) delay optimization by echocardiography and automated intracardiac electrogram (IEGM) methods during supine bicycle exercise
C
Comparator
AV and VV delay optimization at rest
O
Outcome
Variations in optimal AV and VV delays from rest to exercise, and acute haemodynamic impact (intraventricular dyssynchrony and aortic velocity time integral)surrogate
Main Result
p-value: p=<0.001
CRT optimization during exercise yields additional haemodynamic benefits compared to resting optimization, primarily driven by changes in optimal VV delay.
Cite This Study
Valzania et al. (2008) studied Heart failure (n=24). Exercise optimization of VV delay vs. Resting setting optimization was evaluated on Intraventricular dyssynchrony and aortic velocity time integral (p=<0.001). Exercise optimization of VV delay improved intraventricular dyssynchrony and increased aortic velocity time integral compared with the resting setting (P<0.001).