Key result
Current evidence is insufficient to show the superiority of a rate-adaptive AV or VV delay in all cardiac resynchronization therapy patients, as the effects of exercise were heterogeneous.
Why the study?
Does rate-adaptive AV and VV delay optimization during exercise improve outcomes compared to resting optimization in patients with heart failure receiving CRT?
Does rate-adaptive AV and VV delay optimization during exercise improve outcomes compared to resting optimization in patients with heart failure receiving CRT?
Current evidence does not support routine use of rate-adaptive AV or VV delay optimization during exercise for all CRT patients, though individualized programming may be warranted.
Insufficient evidence supports routine rate-adaptive AV/VV optimization in CRT; leaves open individualized exercise programming for future trials.
Should We Optimize CRT During Exercise? Cardiac resynchronization therapy aims at diminishing cardiac dyssynchrony in patients with heart failure. The effect of cardiac resynchronization therapy can be improved by optimization of the atrioventricular (AV) and interventricular (VV) delays. Currently, optimization of these pacing settings is mainly performed during resting conditions. This paper aims to objectively review the current literature about a rate-adaptive AV and VV delay in cardiac resynchronization therapy. The current evidence for a rate-adaptive AV and VV delay comprises only small nonrandomized studies on acute effects. The effect of exercise on the optimal AV delay was heterogeneous between studies. The optimal VV delay was influenced by exercise conditions in some, but not all patients. Possible explanations lie in the heterogeneous electrical and mechanical responses to exercise in patients with a complex disease such as heart failure with asynchronous contraction. Current evidence is insufficient to show the superiority of a rate-adaptive AV or VV delay in all CRT patients. Individualized exercise programming may be warranted in selected patients.
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Bogaard et al. (2010) conducted a review in Heart failure. Rate-adaptive AV and VV delay was evaluated. Current evidence is insufficient to show the superiority of a rate-adaptive AV or VV delay in all cardiac resynchronization therapy patients, as the effects of exercise were heterogeneous.
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