The peak endocardial acceleration method yielded slightly but significantly longer optimal AV delays compared to echocardiography in DDD (202 vs 179 ms) and VDD (145 vs 124 ms) modes (P<0.05).
Cross-Sectional (n=19)
Does the peak endocardial acceleration method correlate with the echocardiographic method for determining optimal atrioventricular delay in patients with complete heart block?
The peak endocardial acceleration method correlates well with echocardiography for determining optimal atrioventricular delay, suggesting pacemaker software could automatically optimize AVD.
Effect estimate: r = 0.78
p-value: p=<0.05
The goal of this study was to compare two methods determining the optimal atrioventicular delay (AVD) in 19 patients implanted with the BEST-Living system for complete heart block. The definition of the optimal AVD was: the AVD with the echo method that provided the longest diastolic filling time without interruption of the A wave, and the AVD with the peak endocardial acceleration (PEA) method, corresponding to the knee of the PEA curve vs AV delay. The amplitude of the PEA was measured for every AVD programmed via an automatic scanner in steps of 60 to 300 ms (40 ms steps): in the VDD pacing mode with a low base rate, to obtain 100% sensed P waves; in DDD with a base rate = sinus rate + 20%, to obtain 100% paced P waves. Echocardiographic (Echo) measurement of the left ventricular filling time were performed in the same AV delay settings in VDD and DDD as the ones tested in the PEA method, which were manually programmed. The optimal AVDs obtained in DDD and those obtained in VDD were compared in the echo and the PEA tests by a paired Student's t-test. The optimal AVDs obtained by both Echo and by PEA were also compared by a paired Student's t-test in VDD and DDD. The r value of the correlation between the optimal AVDs obtained by Echo and those obtained by PEA was calculated. Similar values of optimal AVD were obtained with both methods. The optimal AVDs given by the Echo technique (179 +/- 25 ms in DDD and 124 +/- 18 ms in VDD) were slightly, but significantly shorter than the ones obtained with the PEA method (202 +/- 21 ms in DDD and 145 +/- 18 ms in VDD, P < 0.05). A highly significant difference between AVD VDD and AVD DDD was found with both methods (P < 0.001). The correlation between the AVDs obtained with the echo and the PEA methods was highly significant (r = 0.78, P < 0.01). Pacemaker software could be modified to determine automatically the optimal AVDs to be applied throughout the heart rate range.
Philippe Ritter (Thu,) conducted a cross-sectional in Complete heart block (n=19). Peak endocardial acceleration (PEA) method vs. Echocardiographic (Echo) method was evaluated on Optimal atrioventricular delay (AVD) (r = 0.78, p=<0.05). The peak endocardial acceleration method yielded slightly but significantly longer optimal AV delays compared to echocardiography in DDD (202 vs 179 ms) and VDD (145 vs 124 ms) modes (P<0.05).