What is the clinical evidence from this study?

Study design: Other. Population: Heart failure (n=100). Intervention: BiV + SyncAV Opt vs. BiV Nominal. Primary outcome: QRS duration (QRSd) (p=<.05).

What question did this study set out to answer?

To evaluate the effect of dynamic atrioventricular delay programming (SyncAV) on ventricular electrical synchrony during biventricular pacing using vectorcardiography-derived metrics.

October 20, 2019Journal of ElectrocardiologyOpen Access

Dynamic atrioventricular delay programming improves ventricular electrical synchronization as evaluated by 3D vectorcardiography

Q: What are the key findings of this study?

Bi-ventricular pacing with SyncAV programmed to the optimal offset significantly narrowed QRS duration compared to nominal bi-ventricular pacing (122 vs 137 ms; p<0.05).

Q: What question did this study set out to answer?

To evaluate the effect of dynamic atrioventricular delay programming (SyncAV) on ventricular electrical synchrony during biventricular pacing using vectorcardiography-derived metrics.

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Key result

Bi-ventricular pacing with SyncAV programmed to the optimal offset significantly narrowed QRS duration compared to nominal bi-ventricular pacing (122 vs 137 ms; p<0.05).

Why the study?

Optimal timing of the atrioventricular delay in CRT can improve synchrony in heart failure, motivating evaluation of the impact of SyncAV on electrical synchrony measured by vectorcardiography.

Does dynamic atrioventricular delay programming (SyncAV) improve ventricular electrical synchronization compared to nominal BiV pacing in patients with CRT devices?

Comparison

BiV with SyncAV Opt vs BiV Nominal vs intrinsic conduction

Design

Observer-blinded cross-sectional study

Authors

EEElien B. EngelsRadboud University Nijmegen BTBernard ThibaultElectrophysiology JMJan O. MangualDanaher (United States)

Discussion

Member takes

Implication

May support individualized SyncAV optimization in CRT; leaves open impact on clinical outcomes.

Key Points

To evaluate the effect of dynamic atrioventricular delay programming (SyncAV) on ventricular electrical synchrony during biventricular pacing using vectorcardiography-derived metrics.
Enrolled N=100 patients with heart failure implanted with a cardiac resynchronization therapy device and a quadripolar left ventricular lead.
Acquired 12-lead ECG recordings during three conditions: intrinsic conduction, biventricular pacing with nominal atrioventricular delays (BiV Nominal), and biventricular pacing with optimized SyncAV offsets (BiV + SyncAV Opt).
Vectorcardiography metrics, including QRS duration and 3D QRS area, were analyzed by a blinded observer.
Mean QRS duration narrowed from 166 ± 25 ms during intrinsic conduction to 137 ± 23 ms with BiV Nominal (p < .05 vs. intrinsic) and shortened further to 122 ± 22 ms with BiV + SyncAV Opt (p < .05 vs. BiV Nominal).
Mean 3D QRS area decreased from 90 ± 42 mV*ms during intrinsic conduction to 65 ± 39 mV*ms with BiV Nominal (p < .05 vs. intrinsic) and further reduced to 53 ± 30 mV*ms with BiV + SyncAV Opt (p = .06 vs. BiV Nominal).

Structured PICO

Does dynamic atrioventricular delay programming (SyncAV) improve ventricular electrical synchronization compared to nominal BiV pacing in patients with CRT devices?

Population

100 heart failure patients (29% female, 32% mean ejection fraction) implanted with a CRT device and quadripolar LV lead.

Intervention

Bi-ventricular (BiV) pacing with SyncAV programmed to the optimal offset achieving maximal synchronization (BiV + SyncAV Opt).

Comparator

Intrinsic conduction and BiV pacing with nominal atrioventricular delays (BiV Nominal).

Outcome

Electrical synchrony as measured by vectorcardiography (VCG) derived QRS metrics (QRS duration and 3D QRS area).surrogate

Main Result

Absolute Event Rate: 122% vs 137%

p-value: p=<.05

Patient-specific optimization of atrioventricular delay using SyncAV significantly improves electrical resynchronization beyond conventional CRT programming.

Cite This Study

Engels et al. (2019) studied Heart failure (n=100). BiV + SyncAV Opt vs. BiV Nominal was evaluated on QRS duration (QRSd) (p=<.05). Bi-ventricular pacing with SyncAV programmed to the optimal offset significantly narrowed QRS duration compared to nominal bi-ventricular pacing (122 vs 137 ms; p<0.05).

synapsesocial.com/papers/6a82fd08b8819ff4224ccb52 https://doi.org/10.1016/j.jelectrocard.2019.09.026

Topics

Heart failure HFrEF treatment

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Dynamic atrioventricular delay programming improves ventricular electrical synchronization as evaluated by 3D vectorcardiography

Discussion

Member takes

Implication

Key Points

Structured PICO

Main Result

Cite This Study

Topics

Dynamic atrioventricular delay programming improves ventricular electrical synchronization as evaluated by 3D vectorcardiography

Discussion

Member takes

Implication

Key Points

Structured PICO

Main Result

Cite This Study

Also Consider

Topics

Also Consider