An electrographic AV optimization for the maximum integrative atrioventricular and ventricular resynchronization in CRT

Abstract Background Atrioventricular (AV) delay could affect AV and ventricular synchrony in cardiac resynchronization therapy (CRT). Strategies to optimize AV delay according to optimal AV synchrony (AVopt-AV) or ventricular synchrony (AVopt-V) would potentially be discordant. This study aimed to explore a new AV delay optimization algorithm guided by electrograms to obtain the maximum integrative effects of AV and ventricular resynchronization (opt-AV). Methods Forty-nine patients with CRT were enrolled. AVopt-AV was measured through the Ritter method. AVopt-V was obtained by yielding the narrowest QRS. The opt-AV was considered to be AVopt-AV or AVopt-V when their difference was < 20 ms, and to be the AV delay with the maximal aortic velocity–time integral between AVopt-AV and AVopt-V when their difference was > 20 ms. Results The results showed that sensing/pacing AVopt-AV (SAVopt-AV/PAVopt-AV) were correlated with atrial activation time (Pend-As/Pend-Ap) (P < 0.05). Sensing/pacing AVopt-V (SAVopt-V/PAVopt-V) was correlated with the intrinsic AV conduction time (As-Vs/Ap-Vs) (P < 0.01). The percentages of patients with more than 20 ms differences between SAVopt-AV/PAVopt-AV and SAVopt-V/PAVopt-V were 62.9% and 57.1%, respectively. Among them, opt-AV was linearly correlated with SAVopt-AV/PAVopt-AV and SAVopt-V/PAVopt-V. The sensing opt-AV (opt-SAV) = 0.1 × SAVopt-AV + 0.4 × SAVopt-V + 70 ms (R2 = 0.665, P < 0.01) and the pacing opt-AV (opt-PAV) = 0.25 × PAVopt-AV + 0.5 × PAVopt-V + 30 ms (R2 = 0.560, P < 0.01). Conclusion The SAVopt-AV/PAVopt-AV and SAVopt-V/PAVopt-V were correlated with the atrial activation time and the intrinsic AV conduction interval respectively. Almost half of the patients had a > 20 ms difference between SAVopt-AV/PAVopt-AV and SAVopt-V/PAVopt-V. The opt-AV could be estimated based on electrogram parameters.

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An electrographic AV optimization for the maximum integrative atrioventricular and ventricular resynchronization in CRT

10.21203/rs.3.rs-258870/v1 ◽

2021 ◽

Author(s):

JIE LI ◽

Yuegang Wang ◽

Jingting Mai ◽

Shilan Chen ◽

Menghui Liu ◽

...

Keyword(s):

Cardiac Resynchronization ◽

Conduction Time ◽

Activation Time ◽

Velocity Time Integral ◽

Time Integral ◽

Ventricular Synchrony ◽

Av Conduction ◽

Atrial Activation ◽

Av Synchrony ◽

Av Delay

Abstract Background:Atrioventricular (AV) delay could affect AV and ventricular synchrony in cardiac resynchronization therapy (CRT). Strategies to optimize AV delay according to optimal AV synchrony (AVopt-AV) or ventricular synchrony (AVopt-V) would potentially be in discordant. This study aimed to explore a new AV delay optimization algorithm guided by electrograms to get the maximum integrative effects of AV and ventricular resynchronization (opt-AV).Methods:Forty-nine patients with CRT were enrolled. AVopt-AV was measured through the Ritter method. AVopt-V was obtained by yielding the narrowest QRS. The opt-AV was considered to be AVopt-AV or AVopt-V when their difference was <20ms, and to be the AV delay with the maximal aortic velocity-time integral between AVopt-AV and AVopt-V when their difference was >20ms.Results:The results showed sensing/pacing AVopt-AV (SAVopt-AV/PAVopt-AV) were correlated with atrial activation time (Pend-As/ Pend-Ap)( P＜0.05 ). Sensing/pacing AVopt-V (SAVopt-V/PAVopt-V) were correlated with the intrinsic AV conduction time (As-Vs/Ap-Vs) (P＜0.01). The percentages of patients with more than 20ms differences between SAVopt-AV/PAVopt-AV and SAVopt-V/PAVopt-V were 62.9% and 57.1%, respectively. Among them, the opt-AV were linearly correlated with SAVopt-AV/PAVopt-AV and SAVopt-V/PAVopt-V. The sensing opt-AV (opt-SAV)=0.1×SAVopt-AV+0.4×SAVopt-V+70ms (R2=0.665, P<0.01) and the pacing opt-AV (opt-PAV)=0.25×PAVopt-AV+0.5×PAVopt-V+30ms (R2=0.560, P<0.01).Conclusion:The SAVopt-AV/PAVopt-AV and SAVopt-V/PAVopt-V were correlated with the atrial activation time and the intrinsic AV conduction interval respectively. Almost half of patients had a >20ms difference between SAVopt-AV/PAVopt-AV and SAVopt-V/PAVopt-V. The opt-AV could be estimated based on electrogram parameters.

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Comparison of a non-invasive arterial pulse contour technique and echo Doppler aorta velocity-time integral on stroke volume changes in optimization of cardiac resynchronization therapy

EP Europace ◽

10.1093/europace/euq348 ◽

2010 ◽

Vol 13 (1) ◽

pp. 87-95 ◽

Cited By ~ 40

Author(s):

I. E. van Geldorp ◽

T. Delhaas ◽

B. Hermans ◽

K. Vernooy ◽

B. Broers ◽

...

Keyword(s):

Stroke Volume ◽

Pulse Contour ◽

Cardiac Resynchronization ◽

Arterial Pulse ◽

Resynchronization Therapy ◽

Volume Changes ◽

Velocity Time Integral ◽

Non Invasive ◽

Time Integral ◽

Contour Technique

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OPTIMIZATION ATRIOVENTRICULAR DELAY USING ECHOGRAPHY FOR CARDIAC RESYNCHRONIZATION THERAPY PATIENTS

Journal of Medicine and Pharmacy ◽

10.34071/jmp.2017.5.15 ◽

2017 ◽

pp. 113-118

Author(s):

Tri Thuc Nguyen ◽

Cuu Long Nguyen

Keyword(s):

Cardiac Resynchronization Therapy ◽

Optimization Methods ◽

Left Ventricular ◽

Cardiac Resynchronization ◽

Resynchronization Therapy ◽

Velocity Time Integral ◽

Mitral Inflow ◽

Atrioventricular Delay ◽

Time Integral ◽

Invasive Hemodynamics

Objective: To determine correlation of echo-doppler optimization of atrioventricular delay in cardiac resynchronization therapy with left ventricular invasive hemodynamics optimization. Methods: Intervention prospective study. Result: In 25 patients (48% female, mean age 6.1±10.6, had diagnosis heart failure NYHA IIIV with LVEF= 26.9±5.7%, sinus rhythm, QRS wide is 170±22.1 ms) who underwent CRT. AVsense optimization were determined by invasive LV dP/dtmax, and the Doppler echocardiographic methods evaluated were the velocity–time integral (VTI) of the transmitralflow (EA VTI), the VTI of the LV outflow tractor aorta (LV VTI). The result are 117.8±15.2ms; 117.2±14.5ms and 120.8 ± 12.8ms, prospectively. The optimal AVsense delay with the EA VTI method was most concordant with LV dP/dtmax(r=0,953), LV VTI was less concordant (r=0.568). The result of AVpace optimization by three methods are 159.6±17.9ms; 159±16.2ms và 165±13.8ms, prospectively. The optimal AVpace delay with the EA VTI method was most concordant with LV dP/dtmax (r=0.964), LV VTI was less concordant (r=0.734). Conclusions: Comparing with invasive LV dP/dtmax, measurement of the maximal VTI of mitral inflow is more concordant than LV VTI in AVsense and AVpace optimization. If we optimize AVsense and AVpace, for replacing invasive LV dP/dtmax, EA VTI method was better option. Key words: Dyssychronization, CRT, optimization, dP/dtmax

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QRS duration as a predictor of left ventricular outflow tract velocity time integral in patient with cardiac resynchronization therapy

Journal of Cardiovascular Echography ◽

10.4103/jcecho.jcecho_66_19 ◽

2020 ◽

Vol 30 (2) ◽

pp. 68

Author(s):

MahaMohamed Mohamed Khalifa ◽

Ahmed Said ◽

Ayman Mortada ◽

Hassan Shehata

Keyword(s):

Cardiac Resynchronization Therapy ◽

Left Ventricular Outflow Tract ◽

Ventricular Outflow Tract ◽

Left Ventricular ◽

Cardiac Resynchronization ◽

Resynchronization Therapy ◽

Velocity Time Integral ◽

Time Integral ◽

Left Ventricular Outflow ◽

Qrs Duration

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CRT Pacing: Midterm Follow-Up in LV Only Pacing without RV Lead in Patients with Normal AV Conduction

Journal of Clinical Medicine ◽

10.3390/jcm7120531 ◽

2018 ◽

Vol 7 (12) ◽

pp. 531 ◽

Cited By ~ 1

Author(s):

Dragos Cozma ◽

Cristina Vacarescu ◽

Lucian Petrescu ◽

Cristian Mornos ◽

Emilia Goanta ◽

...

Keyword(s):

Stress Testing ◽

Real Life ◽

Positive Outcome ◽

Left Ventricular ◽

Cardiac Resynchronization ◽

End Diastolic Volume ◽

Av Conduction ◽

Reverse Remodelling ◽

Av Delay

Background: The aim of our study was to assess the real life cardiac resynchronization therapy (CRT) fusion left ventricular (LV) only pacing in patients with normal AV conduction (NAVc) without right ventricular (RV) lead. Methods: Consecutive NAVc patients with CRT indication were implanted with a right atrium RA/LV DDD pacing system. Complete follow-up at 1, 3 and every 6 months thereafter included echocardiography and stress testing. Results: We analysed 55 patients (62 ± 11 years). All patients were responders with significant LV reverse remodelling (LV end-diastolic volume 193.7 ± 81 vs. 243.2 ± 82 mL at baseline, p < 0.002) and increased LV ejection fraction (38 ± 7.9% vs. 27 ± 5.2% at baseline, p < 0.001). Mitral regurgitation decreased in 38 patients (69%). During follow-up (35 ± 18 months), 20 patients (36%) needed reprogramming sensed/paced AV delay or maximum tracking rate (MTR) because of inadequate or lost LV capture at exercise test; personalized programming to achieve up to 100% fusion pacing was used in all patients. One patient developed Mobitz II second degree AV block and triple chamber CRT-P upgrade was performed; defibrillator upgrade was not necessary. Conclusions: LV only pacing CRT-P without RV lead showed a positive outcome in carefully selected patients.

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748 Is nominal AV delay offset optimal for heart failure patients receiving cardiac resynchronization therapy?

EP Europace ◽

10.1016/s1099-5129(05)80494-5 ◽

2005 ◽

Vol 7 ◽

pp. 168-168

Keyword(s):

Heart Failure ◽

Cardiac Resynchronization Therapy ◽

Cardiac Resynchronization ◽

Resynchronization Therapy ◽

Heart Failure Patients ◽

Av Delay

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Doppler evaluation of the posterior cerebral artery in fetuses with transposition of great arteries

Journal of Perinatal Medicine ◽

10.1515/jpm-2019-0176 ◽

2020 ◽

Vol 48 (5) ◽

pp. 504-508

Author(s):

Ya Tan ◽

Shi Zeng ◽

YuShan Liu ◽

HuaYu Tang ◽

BaiHua Zhao

Keyword(s):

Cerebral Artery ◽

Pulsatility Index ◽

Posterior Cerebral Artery ◽

Cerebral Arteries ◽

Peak Systolic Velocity ◽

Transposition Of Great Arteries ◽

Velocity Time Integral ◽

Time Integral ◽

Diastolic Velocity ◽

Doppler Evaluation

AbstractObjectiveTo observe Doppler ultrasound changes in the two segments of the posterior cerebral artery (PCA) in fetuses with transposition of the great arteries (TGA).MethodsThe peak systolic velocity (PSV), end-diastolic velocity (EDV), pulsatility index (PI), and velocity-time integral (VTI) of the two segments of PCA (the first segment: PCAS1, the second segment: PCAS2) and of the middle cerebral artery (MCA) were compared in TGA fetuses and normal fetuses. The abnormality rate between the PCAS1-PI and MCA-PI was compared in TGA fetuses.ResultsThe PCAS1-PI and MCA-PI were smaller in the TGA fetuses than in the controls (all P < 0.05), but the PCAS2-PI was unchanged (P > 0.05). The MCA-VTI, PCAS1-VTI, and PCAS2-VTI were larger in the TGA fetuses (all P < 0.05). In the TGA fetuses, the abnormality rate of the PCAS1-PI was significantly higher than that of the MCA-PI (P < 0.05).ConclusionIn fetuses with TGA, there were hemodynamic differences between the two segments of the posterior cerebral arteries. Moreover, PCAS1 exhibited signs of vasodilatation more obviously than did the MCA in fetuses with TGA.

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Comparing Ventricular Synchrony in Left Bundle Branch and Left Ventricular Septal Pacing in Pacemaker Patients

Journal of Clinical Medicine ◽

10.3390/jcm10040822 ◽

2021 ◽

Vol 10 (4) ◽

pp. 822

Author(s):

Luuk I.B. Heckman ◽

Justin G.L.M. Luermans ◽

Karol Curila ◽

Antonius M.W. Van Stipdonk ◽

Sjoerd Westra ◽

...

Keyword(s):

Left Ventricular ◽

Activation Time ◽

Ventricular Synchrony ◽

Septal Pacing ◽

Ventricular Activation ◽

Qrs Morphology ◽

Conversion Matrix ◽

Qrs Duration ◽

The Right ◽

Electrophysiological Effects

Background: Left bundle branch area pacing (LBBAP) has recently been introduced as a novel physiological pacing strategy. Within LBBAP, distinction is made between left bundle branch pacing (LBBP) and left ventricular septal pacing (LVSP, no left bundle capture). Objective: To investigate acute electrophysiological effects of LBBP and LVSP as compared to intrinsic ventricular conduction. Methods: Fifty patients with normal cardiac function and pacemaker indication for bradycardia underwent LBBAP. Electrocardiography (ECG) characteristics were evaluated during pacing at various depths within the septum: starting at the right ventricular (RV) side of the septum: the last position with QS morphology, the first position with r’ morphology, LVSP and—in patients where left bundle branch (LBB) capture was achieved—LBBP. From the ECG’s QRS duration and QRS morphology in lead V1, the stimulus- left ventricular activation time left ventricular activation time (LVAT) interval were measured. After conversion of the ECG into vectorcardiogram (VCG) (Kors conversion matrix), QRS area and QRS vector in transverse plane (Azimuth) were determined. Results: QRS area significantly decreased from 82 ± 29 µVs during RV septal pacing (RVSP) to 46 ± 12 µVs during LVSP. In the subgroup where LBB capture was achieved (n = 31), QRS area significantly decreased from 46 ± 17 µVs during LVSP to 38 ± 15 µVs during LBBP, while LVAT was not significantly different between LVSP and LBBP. In patients with normal ventricular activation and narrow QRS, QRS area during LBBP was not significantly different from that during intrinsic activation (37 ± 16 vs. 35 ± 19 µVs, respectively). The Azimuth significantly changed from RVSP (−46 ± 33°) to LVSP (19 ± 16°) and LBBP (−22 ± 14°). The Azimuth during both LVSP and LBBP were not significantly different from normal ventricular activation. QRS area and LVAT correlated moderately (Spearman’s R = 0.58). Conclusions: ECG and VCG indices demonstrate that both LVSP and LBBP improve ventricular dyssynchrony considerably as compared to RVSP, to values close to normal ventricular activation. LBBP seems to result in a small, but significant, improvement in ventricular synchrony as compared to LVSP.

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