Adjusting the timing of left-ventricular pacing using electrocardiogram and device electrograms
Adjusting the timing of left-ventricular pacing using electrocardiogram and device electrograms
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DOI：
10.1093/europace/eur146
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发表时间：
2011-10-01
期刊：
影响因子：
6.1
通讯作者：
Sambelashvili, Aleksandre
中科院分区：
文献类型：
--
作者：
Khaykin, Yaariv;Exner, Derek;Sambelashvili, Aleksandre
目的 对于部分窦性心律和保留 AV 传导的心脏再同步治疗 (CRT) 患者，左心室 (LV) 起搏与优化房室 (AV) 时序相比，可能会提供与双心室 (BiV) 起搏相似或更大的益处。我们假设，左心室起搏期间的最佳设备 AV 延迟可以使用心电图 (ECG) 和设备电图来预测。 方法和结果 窦性心律且 PR 间期 < 300 ms 的患者 (n = 55) 将其 CRT 设备编程为具有一系列 AV 的心房和 LV 起搏以及超声心动图优化的 BiV 且无心室起搏。在每种设置下，使用超声心动图评估左心室功能，并确定与最高左心室射血分数（LVEF）、最低左心室收缩末期容积（LVESV）相对应的 AV，并确定两者的平均值（通过 EF 和 ESV）。研究了最佳 AV 与以下间隔之间的相关性：固有 QRS 持续时间 (QRS)、从心房起搏 (Ap) 到右心室 (RV) 感知的间隔 (Ap-RVs)、从 RV 感知到 LV 激活 (RVs-LVs) 以及从 LV 起搏到 RV 感知 (LVp-RVs)。最佳 AV 与内在 Ap-RV 间隔适度相关，而其他参数显示弱相关或无相关。最佳相关性（R = 0.66，P < 0.0001）是根据 EF 和 ESV 的最佳 AV 延迟与 Ap-RVs 间隔之间的关系。在 LV 起搏期间将 AV 编程为最短的固有 Ap-RV 间隔的 70%，或 Ap-RVs-40 ms，可显着改善 LV 功能，类似于 BiV 的情况。结论 LV 起搏期间的最佳 AV 可以根据固有 AV 传导时间来近似。
Aims Left-ventricular (LV) pacing with optimized atrio-ventricular (AV) timing may provide similar or greater benefit in comparison with bi-ventricular (BiV) pacing in a subset of cardiac resynchronization therapy (CRT) patients with sinus rhythm and preserved AV conduction. We hypothesized that the optimal device AV delays during LV pacing can be predicted using electrocardiogram (ECG) and device electrograms.Methods and results Patients (n = 55) with sinus rhythm and PR interval < 300 ms had their CRT devices programmed to atrial and LV pacing with a range of AVs as well as to echocardiographically optimized BiV and no ventricular pacing. At each setting, LV function was evaluated using echocardiography and AVs corresponding to the highest LV ejection fraction (LVEF), lowest LV end-systolic volume (LVESV), and the average of the two (by EF and ESV) were determined. Correlation between the optimal AVs and the following intervals was investigated: intrinsic QRS duration (QRSs), intervals from atrial pacing (Ap) to right-ventricular (RV) sensing (Ap-RVs), from RV sensing to LV activation (RVs-LVs), and from LV pacing to RV sensing (LVp-RVs). Optimal AVs moderately correlated with intrinsic Ap-RVs interval, whereas other parameters showed weak or no correlation. The best correlation (R = 0.66, P < 0.0001) was between the optimal AV delay according to EF and ESV, and Ap-RVs interval. Programming of AVs during LV pacing to the shortest of 70% of the intrinsic Ap-RVs interval, or Ap-RVs-40 ms resulted in significant improvement in LV function similar to that in case of BiV.Conclusion Optimal AV during LV pacing can be approximated from the intrinsic AV conduction time.