Abstract
Cardiac resynchronization therapy (CRT) with hemodynamic optimized biventricular pacing is an established therapy for heart failure patients with sinus rhythm, reduced left ventricular ejection fraction and wide QRS complex. The aim of the study was to evaluate electrical right and left cardiac atrioventricular delay and left atrial delay in CRT responder and non-responder with sinus rhythm. Methods: Heart failure patients with New York Heart Association class 3.0 ± 0.3, sinus rhythm and 27.7 ± 6.1% left ventricular ejection fraction were measured by surface ECG and transesophageal bipolar left atrial and left ventricular ECG before implantation of CRT devices. Electrical right cardiac atrioventricular delay was measured between onset of P wave and onset of QRS complex in the surface ECG, left cardiac atrioventricular delay between onset of left atrial signal and onset of left ventricular signal in the transesophageal ECG and left atrial delay between onset and offset of left atrial signal in the transesophageal ECG. Results: Electrical atrioventricular and left atrial delay were 196.9 ± 38.7 ms right and 194.5 ± 44.9 ms left cardiac atrioventricular delay, and 47.7 ± 13.9 ms left atrial delay. There were positive correlation between right and left cardiac atrioventricular delay (r = 0.803 P < 0.001) and negative correlation between left atrial delay and left ventricular ejection fraction (r = −0.694 P = 0.026) with 67% CRT responder. Conclusions: Transesophageal electrical left cardiac atrioventricular delay and left atrial delay may be useful preoperative atrial desynchronization parameters to improve CRT optimization.
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References
Steinberg, B.A., Wehrenberg, S., Jackson, K.P., Hayes, D.L., Varma, N., Powell, B.D., Day, J.D., Frazier-Mills, C.G., Stein, K.M., Jones, P.W., Piccini, J.P.: Atrioventricular and ventricular-to-ventricular programming in patients with cardiac resynchronization therapy: results from ALTITUDE. J Interv Card Electrophysiol. 44(3), 279–87 (2015).
Gold, M.R., Birgersdotter-Green, U., Singh, J.P., Ellenbogen, K.A., Yu, Y., Meyer, T.E., Seth, M., Tchou, P.J.: The relationship between ventricular electrical delay and left ventricular remodeling with cardiac resynchronization therapy. European Heart Journal 32, 2516–2524 (2011).
Heinke, M., Kühnert, H., Heinke, T., Tumampos, J., Dannberg, G.: Left cardiac atrioventricular delay and interventricular delay in cardiac resynchronization therapy responder and non-responder. Current Directions in Biomedical Engineering. 2(1): 247–250 (2016).
Sinner GJ1, Gupta VA2, Seratnahaei A2, Charnigo RJ3, Darrat YH2, Elayi SC2, Leung SW2, Sorrell VL: Atrioventricular dyssynchrony from empiric device settings is common in cardiac resynchronization therapy and adversely impacts left ventricular morphology and function. Echocardiography, 34(4): 496–503 (2017).
Heinke, M., Ismer, B., Kühnert, H., Figulla, H.R.: Transesophageal left ventricular electrogramm-recording and temporary pacing to improve patient selection for cardiac resynchronization. Med Biol Eng Comput 49: 851–858 (2011).
Engels, E.B., Mafi-Rad, M., Hermans, B.J.M., Aranda, A., van Stipdonk, A.M.W., Rienstra, M., Scheerder, C.O.S., Maass, A.H., Prinzen, F.W., Vernooy, K.: Tailoring device settings in cardiac resynchronization therapy using electrograms from pacing electrodes. Europace https://doi.org/10.1093/europace/eux208. [Epub ahead of print] (2017).
Lee, A.W., Crozier, A., Hyde, E.R., Lamata, P., Truong, M., Sohal, M., Jackson, T., Behar, J.M., Claridge, S., Shetty, A., Sammut, E., Plank, G., Rinaldi, C.A., Niederer. S.: Biophysical Modeling to Determine the Optimization of Left Ventricular Pacing Site and AV/VV Delays in the Acute and Chronic Phase of Cardiac Resynchronization Therapy. J Cardiovasc Electrophysiol. 28(2):208–215. https://doi.org/10.1111/jce.13134. (2017).
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Heinke, M., Dannberg, G., Heinke, T., Kühnert, H. (2019). Electrical Right and Left Cardiac Atrioventricular and Left Atrial Delay in Cardiac Resynchronization Therapy Responder and Non-responder with Sinus Rhythm. In: Lhotska, L., Sukupova, L., Lacković, I., Ibbott, G. (eds) World Congress on Medical Physics and Biomedical Engineering 2018. IFMBE Proceedings, vol 68/2. Springer, Singapore. https://doi.org/10.1007/978-981-10-9038-7_25
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DOI: https://doi.org/10.1007/978-981-10-9038-7_25
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