Should we use the rate-adaptive AV delay in cardiac resynchronization therapy-pacing?
Key result
Exercise shortens optimal AV delay by ~9 ms in CRT-ICD patients, suggesting deactivation of rate-adaptive delays.
- MD -8.8 ms
- P=0.014
- n=20
Why the study?
Recommendations for programming the rate-adaptive AV delay in CRT were unclear and required investigation.
Does submaximal exercise change the optimal AV delay in CRT-ICD patients compared to rest?
Population
20 CRT-ICD patients
Comparison
Submaximal ergometric exercise (71 +/- 9 W) vs rest
Design
Observational study measuring AV delay components during rest and exercise
Authors
Discussion
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Implication
May support deactivating rate-adaptive AV delay in CRT-ICD during exercise; hypothesis-generating pending randomized outcome trials.
Study Design
Type
Observational (n=20)
Structured PICO
Does submaximal exercise change the optimal AV delay in CRT-ICD patients compared to rest?
P
Population
20 CRT-ICD patients evaluated during rest and submaximal ergometric exercise.
E
Exposure
Submaximal ergometric exercise (71 +/- 9 W)
C
Comparator
Rest
O
Outcome
Optimal AV delay (AVD(opt)) and its components (IACT, LA-EAC(long), S(V)-EAC(short))surrogate
Main Result
Mean Difference: -8.8
p-value: p=0.014
The study suggests that rate-adaptive AV delay should be deactivated in CRT pacing due to minimal clinically relevant changes during exercise.
Cite This Study
Melzer et al. (2007) conducted an observational in Cardiac resynchronization therapy (CRT-ICD) (n=20). Submaximal ergometric exercise vs. Rest was evaluated on Optimal AV delay in DDD pacing (AVD(optDDD)) (MD -8.8 ms, p=0.014). Submaximal exercise in CRT-ICD patients significantly shortened the optimal AV delay in DDD pacing by 8.8 ± 14.5 ms (P=0.014), suggesting rate-adaptive AV delay should be deactivated.