Skip to main content
SpringerLink
Log in

Impact of moderate exercise workload on predicted optimal AV and VV delays determined by an intracardiac electrogram-based method for optimizing cardiac resynchronization therapy

  • Original Paper
  • Published:
Clinical Research in Cardiology Aims and scope Submit manuscript

Abstract

Aims

Aim of this study is to evaluate reproducibility, consistency and the impact of moderate exercise workload on optimized PV and VV delays as determined by the IEGM-based QuickOpt™ method (St. Jude Medical), that was shown to produce hemodynamic performance similar to that obtained by echo-guided aortic VTI maximization.

Methods

Sixty patients with CRT-ICD (65 ± 9 years, 12% female, LVEF 28 ± 9%, 48% CAD and 52% DCM) were enrolled. IEGM-based PV/VV optimization was conducted six times: twice at rest, twice immediately after a 6-min walk test and twice following a 3-min recovery period. Timing cycle delays were programmed in accordance with the optimization results. Follow-up was performed after 1 year.

Results

Although significant difference in heart rate was reached [68 ± 9 bpm (REST) vs. 79 ± 12 (6MWT), p < 0.001], differences were not observed between IEGM-based optimized PV/VV delays: PVopt = 128 ± 14 ms (REST) versus 130 ± 17 ms (6MWT) versus 129 ± 16 ms (RECOV); VVopt = 15 ± 24 ms (REST) versus 15 ± 22 ms (6MWT) versus 16 ± 24 ms (RECOV). During 1-year follow-up PVopt and VVopt remained stable (ΔPVopt = 10 ± 10 ms, ΔVVopt = 9 ± 11 ms).

Conclusion

Optimized IEGM-based timing cycle delays are independent of moderate exercise status within a particular patient but varied between patients. This supports the use of PV/VV optimization in each CRT patient.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Baker JH, McKenzie J III, Beau S, Greer GS, Portefield J, Fedor M, Greenberg S, Daoud EG, Corbisiero R, Bailey JR, Porterfield L (2007) Acute evaluation of programmer-guided AV/PV and VV delay optimization comparing an IEGM method and echocardiogram for cardiac resynchronization therapy in heart failure patients and dual chamber ICD implants. J Cardiovasc Electrophysiol 18:185–191

    Article  PubMed  Google Scholar 

  2. Bordachar P, Lafitte S, Reuter S, Sanders P, Jaïs P, Haïssaguerre M, Roudaut R, Garrigue S, Clementy J (2004) Echocardiographic parameters of ventricular dyssynchrony validation in patients with heart failure using sequential biventricular pacing. J Am Coll Cardiol 44(11):2157–2165

    Article  PubMed  Google Scholar 

  3. Frankenstein L, Zugk C, Nelles M, Schellberg D, Remppis A, Katus H (2008) Primary ICD therapy in patients with advanced heart failure: selection strategies and future trials. Clin Res Cardiol 97(9):594–600

    Article  PubMed  Google Scholar 

  4. Kerlan JE, Sawhney NS, Waggoner AD, Chawla MK, Garwhal S, Osborn JL, Faddis MN (2006) Prospective comparison of echocardiographic atrioventricular delay optimization methods for cardiac resynchronization. Heart Rhythm 3(2):148–154

    Article  PubMed  Google Scholar 

  5. Khairy P, Talajic M, Dominguez M, Tardif JC, Juneau M, Lavoie L, Roy D, Dubuc M (2001) Atrioventricular interval optimization and exercise tolerance. Pacing Clin Electrophysiol 24:1534–1540

    Article  CAS  PubMed  Google Scholar 

  6. Meine M, Min X, Kordmann M, Park EJ, Trappe HJ (2004) IEGM based method for estimating optimal AV delay in cardiac resynchronization therapy. Europace 6 (Suppl 1) 116:149/2

    Google Scholar 

  7. Melzer C, Bondke H, Körber T, Nienhaber C, Baumann G, Ismer B (2008) Should we use the rate adaptive AV delay in cardiac resynchronization therapy-pacing? Europace 10:53–58

    Article  PubMed  Google Scholar 

  8. Min X, Meine M, Baker JH, Pires LA, Turk KT, Horn EM, Kowal RC, Paris M, Park E, Fain ES (2007) Estimation of the optimal VV delay by an IEGM-based method in cardiac resynchronization therapy. Pacing Clin Electrophysiol 30:S19–S22

    Article  PubMed  Google Scholar 

  9. Porciani MC, Rao CM, Mochi M, Capelli F, Bongiorno G, Perini AP, Lilli A, Ricciardi G, Hashtroudi L, Silvestri P, Barold SS, Padeletti L (2008) A real-time three-dimensional echocardiographic validation of an intracardiac electrogram-based method for optimizing cardiac resynchronization therapy. Pacing Clin Electrophysiol 31(1):56–63

    Article  PubMed  Google Scholar 

  10. Rom R, Erel J, Glikson M, Rosenblum K, Ginosar R, Hayes D (2005) Adaptive cardiac resynchronization therapy device: a simulation report. Pacing Clin Electrophysiol 28:1168–1173

    Article  PubMed  Google Scholar 

  11. Sawhney NS, Waggoner AD, Garhwal S, Chawla MK, Osborn J, Faddis MN (2004) Randomized prospective trial of atrioventricular delay programming for cardiac resynchronization therapy. Heart Rhythm 1(5):562–567

    Article  PubMed  Google Scholar 

  12. Scharf C, Li P, Muntwyler J, Chugh A, Oral H, Pelosi F, Morady F, Armstrong WF (2005) Rate-dependent AV delay optimization in cardiac resynchronization therapy. Pacing Clin Electrophysiol 28:279–284

    Article  PubMed  Google Scholar 

  13. Soogard P, Egeblad H, Pedersen AK, Kim WY, Kristensen BO, Hansen PS, Mortensen PT (2002) Sequential versus simultaneous biventricular resynchronization for severe heart failure: evaluation by tissue Doppler imaging. Circulation 106:2078–2084

    Article  Google Scholar 

  14. Swedberg K, Cleland J, Dargie H, Drexler H, Follath F, Komadja M, Tavazzi L, Smiseth OA, Gavazzi A, Haverich A, Hoes A, Jaarsma T, Korewicki J, Lévy S, Linde C, Lopez-Sendon JL, Nieminen MS, Piérard L, Remme WJ (2005) Guidelines fort he diagnosis and treatment of chronic heart failure: executive summary. Eur Heart J 26:1115–1140 (update 2005)

    Article  PubMed  Google Scholar 

  15. Valzania C, Biffi M, Matrignani C, Diemberger I, Bertini M, Ziacchi M, Bacchi L, Rocchi G, Rapezzi C, Branzi A, Boriani G (2007) Cardiac resynchronization therapy: variations in echo-guided optimized atrioventricular and interventricular delays during follow-up. Echocardiography 24(9):933–939

    Article  PubMed  Google Scholar 

  16. Valzania C, Eriksson MJ, Boriani G, Gadler F (2008) Cardiac resynchronization therapy during rest and exercise: comparison of two optimization methods. Europace 10(10):1161–1169

    Article  PubMed  Google Scholar 

  17. Whinnett ZI, Briscoe C, Davies JE, Willson K, Manisty CH, Davies DW, Peters NS, Kanagaratnam P, Hughes AD, Mayet J, Francis DP (2008) The atrioventricular delay of cardiac resynchronization can be optimized hemodynamically during exercise and predicted from resting measurements. Heart Rhythm 5(3):378–386

    Article  PubMed  Google Scholar 

  18. Whinnett ZI, Davies JE, Willson K, Chow AW, Foale RA, Davies DW, Hughes AD, Mayet J, Francis DP (2006) Determination of optimal atrioventricular delay for cardiac resynchronization therapy using acute non-invasive blood pressure. Europace 8(5):358–366

    Article  PubMed  Google Scholar 

  19. Zipes DP, Camm AJ, Borggrefe M, Buxton AE, Chaitman B, Fromer M, Gregoratos G, Klein G, Moss AJ, Myerburg RJ, Priori SG, Quinones MA, Roden DM, Silka MJ, Tracy C, Priori SG, Blanc JJ, Budaj A, Camm AJ, Dean V, Deckers JW, Despres C, Dickstein K, Lekakis J, McGregor K, Metra M, Morais J, Osterspey A, Tamargo JL, Zamorano JL, Smith SC Jr, Jacobs AK, Adams CD, Antman EM, Anderson JL, Hunt SA, Halperin JL, Nishimura R, Ornato JP, Page RL, Riegel B (2006) ACC/AHA/ESC guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. Europace 8:746–837

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

We would like to express our gratitude to our study nurse Petra Zaricor for her great help in patient management and data acquisition in performing this study. We would like to thank Dirk Hild for his help in acquisition of data and patient follow-up. Furthermore, Rita Omega Ella and Kristof Daems, St Jude Medical, Brussels Coordination Center, are acknowledged for statistical analyses and advices.

Author information

Authors and Affiliations

  1. Arrhythmia Center, Heart Center Ludwigshafen, Bremserstr 79, 67063, Ludwigshafen, Germany

    Margit Strauss, Torsten Becker, Thomas Kleemann, Ngoc Dyck & Karlheinz Seidl

  2. St. Jude Medical GmbH, Eschborn, Germany

    Frank Birkenhauer

Authors
  1. Margit Strauss
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Torsten Becker
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Thomas Kleemann
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ngoc Dyck
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Frank Birkenhauer
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Karlheinz Seidl
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Margit Strauss.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Strauss, M., Becker, T., Kleemann, T. et al. Impact of moderate exercise workload on predicted optimal AV and VV delays determined by an intracardiac electrogram-based method for optimizing cardiac resynchronization therapy. Clin Res Cardiol 99, 735–741 (2010). https://doi.org/10.1007/s00392-010-0178-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00392-010-0178-y

Keywords

Search

Navigation