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Optimierte Programmierung der atrio-ventrikulären und ventrikulo-ventrikulären Verzögerungszeiten bei Patienten unter biventrikulärer Stimulation – ein pragmatischer Ansatz

Optimized programming during cardiac resynchronization therapy

  • BEITRAG ZUM THEMENSCHWERPUNKT
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Herzschrittmachertherapie + Elektrophysiologie Aims and scope Submit manuscript

Abstract

Cardiac resynchronization (CRT) has evolved as a therapeutic add-on tool in patients with refractory heart failure. Additional pacing of the left ventricle leads to relevant clinical and hemodynamic improvement. Optimized programming of these pacing systems may modulate therapeutic efficacy. Optimal atrio-ventricular (AV) and ventriculo-ventricular (VV) delay programming is documented to increase invasively and non-invasively determined parameters of cardiac hemodynamics.

In this manuscript different options for determining optimal AV and VV delay are discussed and a pragmatic approach to optimize CRT programming is detailed. VV delay needs to be optimized as a first step of programming. Different techniques may estimate the individual need for sequential ventricular pacing. Especially electrocardiographic criteria during right and left ventricular pacing may approximate the time-delay for pre-excitation. Delay between aortic and pulmonic valve ejection can be determined using Doppler echocardiography may identify patients who benefit from sequential pacing.

Optimizing AV delay is a domain of Doppler echocardiography where using a simple formula the AV delay that produces the best diastolic resynchronization of left atrial contraction and left ventricular ejection can be calculated.

Using the above mentioned techniques a pragmatic, easy and fast method for increasing CRT performance can be established. In cases of worsening heart failure or relevant changes of left ventricular dimensions adaptions (re-optimization) of VV and AV delay may be needed.

Zusammenfassung

Die kardiale Resynchronisation (CRT) mittels biventrikulärer Stimulation hat sich als Therapieoption in der Behandlung der therapie-refraktären schweren Herzinssuffizienz etabliert. Die zusätzliche Stimulation des linken Ventrikels führt zu einer relevanten klinischen und hämodynamischen Verbesserung. Die optimierte Programmierung dieser Stimulationssysteme kann allerdings ebenfalls einen modulierenden Effekt auf den Therapieerfolg haben. So zeigen invasiv und nicht-invasiv bestimmbare Parameter der kardialen Hämodynamik einen Vorteil der optimierten Programmierung der atrioventrikulären (AV) und ventrikulo-ventrikulären (VV) Verzögerungszeiten.

In diesem Beitrag werden nicht-invasive Optimierungsmöglichkeiten der AV-Zeit- und VV-Zeit-Programmierung dargestellt und ein pragmatisches Vorgehen zur Optimierung der CRT-Systeme geliefert. Unterschiedliche Verfahren (Doppler-Echokardiographie, Gewebedoppler, Elektrokardiographie) können zur Abschätzung der Notwendigkeit einer vorwiegend linksventrikulären Präexzitation dienen. Die in einem nächsten Schritt durchgeführte Optimierung der AV-Zeit kann mittels Doppler-echokardiographische anhand einer Formel errechnet werden. Dieses Vorgehen stellt eine einfache und wenig-aufwendige Möglichkeit zur Verbesserung der Performance von CRT-Systemen dar.

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Authors and Affiliations

  1. Herzzentrum der Ruhr-Universität Bochum, BG Universitätsklinik Bergmannsheil Bochum, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany

    T. Deneke, B. Lemke, M. Horlitz, A. Drüke, A. Mügge, P. H. Grewe & T. Lawo

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  1. T. Deneke
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  2. B. Lemke
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  3. M. Horlitz
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  4. A. Drüke
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  6. P. H. Grewe
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  7. T. Lawo
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Correspondence to T. Deneke.

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Deneke, T., Lemke, B., Horlitz, M. et al. Optimierte Programmierung der atrio-ventrikulären und ventrikulo-ventrikulären Verzögerungszeiten bei Patienten unter biventrikulärer Stimulation – ein pragmatischer Ansatz. Herzschr. Elektrophys. 19, 11–18 (2008). https://doi.org/10.1007/s00399-008-0597-x

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