March 1, 2015Journal of Cardiovascular Translational ResearchOpen Access

Vectorcardiography for Optimization of Stimulation Intervals in Cardiac Resynchronization Therapy

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Heart failure with cardiac resynchronization therapy (n=38). Intervention: Vectorcardiography-based optimization of AV and VV intervals vs. Hemodynamic and mechanical optimization methods. Primary outcome: Difference between stimulation interval with smallest QRS vector area and interval with maximal hemodynamic response (Median difference 10 ms).

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Key result

Vectorcardiography analysis of the smallest QRS vector area accurately identified optimal stimulation intervals for cardiac resynchronization therapy, closely matching intervals with maximal hemodynamic response (median difference 10 ms).

Why the study?

Does vectorcardiography-based optimization of stimulation intervals improve hemodynamic response and reduce systolic stretch in patients with CRT?

Population

38 patients implanted with a cardiac resynchronization therapy device at least 3 months prior, including 20…

Comparison

Optimization of atrioventricular and… vs Nominal CRT settings and noninvasive hemodynamic…

Design

Cohort, All assessors were blinded to the results from the other methods.

Authors

CDCaroline J.M. van Deursen LWLiliane Wecke WEWouter M. van Everdingen

Discussion

Member takes

Overview

May streamline CRT interval optimization; leaves open whether VCG guidance improves outcomes in prospective trials.

Study Design

Type

Observational (n=38)

Blinding

Single-blind

Multicenter

Yes

Structured PICO

Does vectorcardiography-based optimization of stimulation intervals improve hemodynamic response and reduce systolic stretch in patients with CRT?

Population

38 patients with heart failure and a cardiac resynchronization therapy device underwent acute pacing protocols to evaluate vectorcardiography for interval optimization.

Intervention

Optimization of atrioventricular (AV) and interventricular (VV) stimulation intervals using 3D vectorcardiography (VCG) to identify the smallest QRS vector area (QRSVAREA) and 12-lead ECG to identify optimal QRS amplitude.

Comparator

Nominal CRT settings (e.g., AV interval of 120 ms, simultaneous BiV pacing) and noninvasive hemodynamic measurements (finger blood pressure, echocardiography).

Outcome

Identification of stimulation intervals with minimal systolic stretch and maximal hemodynamic response (ΔHEMO) compared to baseline.surrogate

Main Result

Effect estimate: Median difference 10 ms

Vectorcardiography and 12-lead ECG can reliably identify optimal AV and VV intervals in CRT patients, offering a highly reproducible alternative to time-consuming hemodynamic optimization.

Limitations

Relatively small proof of principle study
Only investigated acute hemodynamic response, not long-term clinical outcomes
Only investigated patients with a right-to-left ventricular activation pattern (LBBB and RV pacing)
ECG measurements were performed manually rather than using digital calipers
Small sample size

Cite This Study

Deursen et al. (2015) conducted an observational in Heart failure with cardiac resynchronization therapy (n=38). Vectorcardiography-based optimization of AV and VV intervals vs. Hemodynamic and mechanical optimization methods was evaluated on Difference between stimulation interval with smallest QRS vector area and interval with maximal hemodynamic response (Median difference 10 ms). Vectorcardiography analysis of the smallest QRS vector area accurately identified optimal stimulation intervals for cardiac resynchronization therapy, closely matching intervals with maximal hemodynamic response (median difference 10 ms).

synapsesocial.com/papers/6a6e1b6bfebe604dd707e271 https://doi.org/10.1007/s12265-015-9615-7

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March 1, 2015Journal of Cardiovascular Translational ResearchOpen Access

Vectorcardiography for Optimization of Stimulation Intervals in Cardiac Resynchronization Therapy

View Full Paper

Ask AI

Bookmark

Key result

Why the study?

Does vectorcardiography-based optimization of stimulation intervals improve hemodynamic response and reduce systolic stretch in patients with CRT?

Population

38 patients implanted with a cardiac resynchronization therapy device at least 3 months prior, including 20…

Comparison

Optimization of atrioventricular and… vs Nominal CRT settings and noninvasive hemodynamic…

Design

Cohort, All assessors were blinded to the results from the other methods.

Authors

CDCaroline J.M. van Deursen LWLiliane Wecke WEWouter M. van Everdingen

Discussion

Member takes

Overview

May streamline CRT interval optimization; leaves open whether VCG guidance improves outcomes in prospective trials.

Study Design

Type

Observational (n=38)

Blinding

Single-blind

Multicenter

Yes

Structured PICO

Does vectorcardiography-based optimization of stimulation intervals improve hemodynamic response and reduce systolic stretch in patients with CRT?

Population

38 patients with heart failure and a cardiac resynchronization therapy device underwent acute pacing protocols to evaluate vectorcardiography for interval optimization.

Intervention

Comparator

Nominal CRT settings (e.g., AV interval of 120 ms, simultaneous BiV pacing) and noninvasive hemodynamic measurements (finger blood pressure, echocardiography).

Outcome

Identification of stimulation intervals with minimal systolic stretch and maximal hemodynamic response (ΔHEMO) compared to baseline.surrogate

Main Result

Effect estimate: Median difference 10 ms

Vectorcardiography and 12-lead ECG can reliably identify optimal AV and VV intervals in CRT patients, offering a highly reproducible alternative to time-consuming hemodynamic optimization.

Limitations

Relatively small proof of principle study
Only investigated acute hemodynamic response, not long-term clinical outcomes
Only investigated patients with a right-to-left ventricular activation pattern (LBBB and RV pacing)
ECG measurements were performed manually rather than using digital calipers
Small sample size

Cite This Study

synapsesocial.com/papers/6a6e1b6bfebe604dd707e271 https://doi.org/10.1007/s12265-015-9615-7

Also Consider

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

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