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
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
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DOI：
10.1111/j.1540-8167.2006.00671.x
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发表时间：
2007-02-01
影响因子：
2.7
通讯作者：
Porterfield, Linda
中科院分区：
文献类型：
--
作者：
Baker, James H., II;McKenzie, John, III;Porterfield, Linda
使用IEGM方法优化心内延迟简介：双心室和双腔起搏器械的心内延迟优化目前依赖于耗时的超声心动图测量。开发了一种用于房室（AV/PV）和室间（VV）延迟优化的新型心内电图（IEGM）方法，可在常规器械随访期间执行。方法和结果：在这项前瞻性、非随机、多中心试验中，既往植入过St. Jude Medical心脏除颤器（CRT-D）或双腔植入式心律转复除颤器（ICD）的患者在多普勒超声心动图测量最大主动脉速度时间积分（主动脉VTI）的指导下进行标准AV/PV和/或VV延迟优化。然后在所有患者中获得应用IEGM方法推荐延迟的主动脉VTI测量。58例患者（年龄：68 ± 11岁; 81%男性; 74%缺血性）和57例患者（年龄：71 ± 10岁; 74%男性; 71%缺血性）分别入组AV/PV和VV延迟评价。一个独立的核心实验室确定了最大主动脉VTI，AV、PV和VV延迟的数据分析表明，标准方法主动脉VTI值与IEGM方法主动脉VTI值之间的一致性相关系数（CCC）分别为97.5%、96.1%和96.6%。结论：基于程控仪的IEGM方法为CRT-D和双腔ICD患者AV/PV和VV延迟设置的优化提供了一种可靠和简单的替代标准技术。
Intracardiac Delay Optimization Using IEGM Method. Introduction: Intracardiac delay optimization of biventricular and dual-chamber pacing devices currently relies on time-consuming echocardiographic measurements. A novel intracardiac electrogram (IEGM) method for atrioventricular (AV/PV) and interventricular (VV) delay optimization was developed, which can be performed during routine device follow-up.Methods and Results: In this prospective, nonrandomized, multi-center trial, patients previously implanted with St. Jude Medical cardiac resynchronization therapy defibrillator (CRT-D) devices or dual-chamber implantable cardioverter defibrillators (ICDs) underwent standard AV/PV and/or VV delay optimization guided by Doppler echocardiogram measurements of the maximum aortic velocity time integral (aortic VTI). Aortic VTI measurements applying the IEGM method recommended delays were then obtained in all patients. Fifty-eight patients (age: 68 +/- 11 years; 81% male; 74% ischemic) and 57 patients (age: 71 +/- 10 years; 74% male; 71% ischemic) were enrolled for AV/PV and VV delay evaluation, respectively. An independent core lab determined the maximum aortic VTIs.Data analysis of the AV, PV, and VV delays demonstrated the concordance correlation coefficient (CCC) between the standard method aortic VTI values and the IEGM method aortic VTI values was 97.5%, 96.1%, and 96.6%, respectively. All analyses demonstrated that the CCC > 90% (P < 0.05).Conclusion: The automated programmer-based IEGM method provides a reliable and simpler alternative to standard techniques for the optimization of AV/PV and VV delay settings in patients with CRT-D devices and dual-chamber ICDs.