Key result
Combined atrioventricular and interventricular delay optimization significantly increased cardiac output to 5.76 L/min compared to 5.45 L/min with atrioventricular optimization alone in patients receiving cardiac resynchronization therapy.
Why the study?
Does combined AV and VV optimization improve acute cardiac output compared to AV optimization alone in patients receiving cardiac resynchronization therapy?
Does combined AV and VV optimization improve acute cardiac output compared to AV optimization alone in patients receiving cardiac resynchronization therapy?
Absolute Event Rate: 5.76% vs 5.45%
p-value: p=<0.001
Interventricular (VV) optimization provides additional acute hemodynamic benefit over AV optimization alone in CRT patients, specifically helping to overcome suboptimal LV lead placement when the lead is adjacent to the most delayed segment.
May support VV optimization for acute CRT gains; hypothesis-generating and should not yet change practice.
AIMS: Left ventricular (LV) lead placement to the most delayed segment offers the greatest potential benefit to cardiac resynchronization therapy (CRT). We assessed the impact of interventricular (VV) optimization on acute changes in cardiac output (CO) in patients with and without LV pacing of the most delayed segment. METHODS AND RESULTS: In 124 patients, the most delayed segment was defined by speckle tracking radial strain and the LV lead position by biplane fluoroscopy. Patients were classified as either a concordant (LV lead at latest site), adjacent (within one segment), or remote (two or more segments away) LV lead. Atrioventricular (AV) and VV delays were optimized by echocardiography. Cardiac output was measured non-invasively and a >20% increase in CO from baseline (intrinsic) defined acute response. Changes in CO in patients with concordant, adjacent, or remote LV leads were recorded following atrioventricular optimization alone (AV OPT) and after combined AV and VV optimization (AV/VV OPT). Compared with AV OPT pacing, AV/VV OPT produced a greater rise in CO (5.45 ± 1.1 vs. 5.76 ± 1.2 L/min, P< 0.001) and higher acute response rates (48.4 vs. 61.3%, P= 0.041). In adjacent patients, compared with AV OPT pacing, AV/VV OPT settings increased the response rate from 36.4 to 63.6% (P= 0.037). VV optimization had no effect on acute response rates in patients with remote (26.7 vs. 33.3%, P = 0.581) or concordant LV leads (65.6 vs. 72.1%, P = 0.438). CONCLUSION: VV optimization overcomes some but not all of the deleterious effects of a suboptimal LV lead position.
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Khan et al. (2011) studied Advanced heart failure (n=124). Combined atrioventricular and interventricular (AV/VV) delay optimization vs. Atrioventricular optimization alone (AV OPT) was evaluated on Cardiac output (L/min) (p=<0.001). Combined atrioventricular and interventricular delay optimization significantly increased cardiac output to 5.76 L/min compared to 5.45 L/min with atrioventricular optimization alone in patients receiving cardiac resynchronization therapy.
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