Key result
Systematic atrioventricular delay optimization was associated with a significantly greater proportion of patients achieving >97% biventricular pacing compared to controls (78% vs. 50%, p=0.021).
Why the study?
Suboptimal device programming can reduce response to CRT, but whether systematic optimization is beneficial remains unclear, particularly late after implantation.
Does systematic atrioventricular delay (AVD) optimization improve echocardiographic and device parameters in patients undergoing CRT optimization?
Cohort (n=81)
No
Does systematic atrioventricular delay (AVD) optimization improve echocardiographic and device parameters in patients undergoing CRT optimization?
Absolute Event Rate: 78% vs 50%
p-value: p=0.021
Systematic atrioventricular delay optimization in CRT patients is associated with improved biventricular pacing and favorable left ventricular remodeling.
AVD adaptation may improve mechanical synchrony in CRT; hypothesis-generating and requires randomized trials before practice change.
BACKGROUND: Suboptimal device programming is among the reasons for reduced response to cardiac resynchronization therapy (CRT). However, whether systematic optimization is beneficial remains unclear, particularly late after CRT implantation. The aim of this single-center cohort study was to assess the effect of systematic atrioventricular delay (AVD) optimization on echocardiographic and device parameters. METHODS: Patients undergoing CRT optimization at the University Hospital Zurich between March 2011 and January 2013, for whom a follow-up was available, were included. AVD optimization was based on 12-lead electrocardiography (ECG) and echocardiographic left ventricular inflow characteristics. Parameters were assessed at the time of CRT optimization and follow-up, and were compared between patients with AVD optimization (intervention group) and those for whom no AVD optimization was deemed necessary (control group). RESULTS: Eighty-one patients with a mean age of 64 ± 11 years were included in the analysis. In 73% of patients, AVD was deemed suboptimal and was changed accordingly. After a median follow-up time of 10.4 (IQR 6.2 to 13.2) months, the proportion of patients with sufficient biventricular pacing (> 97% pacing) was greater in the intervention group (78%) compared to controls (50%). Furthermore, AVD adaptation was associated with an improvement in interventricular mechanical delay (decrease of 6.6 ± 26.2 ms vs. increase of 4.3 ± 17.7 ms, p = 0.034) and intraventricular septal-to-lateral delay (decrease of 0.9 ± 48.1 ms vs. increase of 15.9 ± 15.7 ms, p = 0.038), as assessed by tissue Doppler imaging. Accordingly, a reduction was observed in mitral regurgitation along with a trend towards reduced left ventricular volumes. CONCLUSIONS: In this "real-world" setting systematic AVD optimization was associated with beneficial effects regarding biventricular pacing and left ventricular remodeling. These data show that AVD optimization may be advantageous in selected CRT patients.
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Korach et al. (2020) conducted a cohort in Heart failure with reduced ejection fraction (HFrEF) with CRT (n=81). Atrioventricular delay (AVD) optimization vs. No AVD optimization (AVD unchanged) was evaluated on Proportion of patients with >97% biventricular pacing at follow-up (p=0.021). Systematic atrioventricular delay optimization was associated with a significantly greater proportion of patients achieving >97% biventricular pacing compared to controls (78% vs. 50%, p=0.021).
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