Cardiac Resynchronization Therapy beyond Nominal Settings: An IEGM-Based Approach for Paced and Sensed Atrioventricular Delay Offset Optimization in Daily Clinical Practice
Abstract
:1. Introduction
2. Materials and Methods
2.1. Patient Population
2.2. Device Implantation
2.3. Echocardiographic Optimization Protocol
2.4. IEGM Method
2.5. Follow Up
2.6. Statistical Analyses
3. Results
3.1. Echocardiographic AV Optimization
3.2. IEGM-Based AV Delays
3.3. CRT Response
4. Discussion
4.1. AV Optimization Methods
4.2. AV Delay: Selected Groups and Outcome Markers
4.3. Study Limitations
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Patient Population (n = 328) | |
---|---|
Demographics | |
Male gender, % (n) | 64 (210) |
Age, years | 69 ± 12 |
BMI, kg/m2 | 27.8 ± 4.7 |
Weight, kg | 84 ± 15 |
Height, cm | 174 ± 9 |
Medical history | |
Hypertension, % (n) | 43 (142) |
Diabetes mellitus, % (n) | 26 (84) |
Coronary artery disease, % (n) | 50 (164) |
Myocardial infarction, % (n) | 38 (125) |
CABG, % (n) | 17 (57) |
Dilated cardiomyopathy, % (n) | 52 (171) |
History of atrial fibrillation, % (n) | 20 (66) |
Clinical profile | |
Systolic blood pressure, mmHg | 119 ± 20 |
Diastolic blood pressure, mmHg | 72 ± 11 |
NYHA class, % (n) | |
I | 3 (10) |
II | 69 (226) |
III | 27 (89) |
IV | 1 (3) |
ECG | |
Heart rate, bpm | 73 ± 14 |
PQ duration, ms | 186 ± 41 |
QRS duration, ms | 159 ± 20 |
Echocardiography | |
LV ejection fraction, % | 25 ± 8 |
LV end diastolic diameter, mm | 61 ± 9 |
LV end-systolic diameter, mm | 51 ± 10 |
LV end diastolic volume, mL | 191 ± 78 |
LV the end-systolic volume, mL | 142 ± 67 |
LA the end-systolic volume, mL | 74 ± 26 |
LA volume index †, mL/m2 | 38 ± 13 |
Mitral regurgitation *, % (n) | 51 (168) |
Tricuspid regurgitation *, % (n) | 27 (87) |
Implantation | |
Upgrade, % (n) | 22 (73) |
CRT-P, % (n) | 6 (20) |
CRT-D, % (n) | 94 (308) |
Lead position | |
Anterolateral | 2 (8) |
Lateral | 12 (38) |
Posterolateral | 72 (235) |
Posterior | 11 (36) |
Transvenous LV lead, % (n) | 91 (298) |
Medication use | |
β-blocker, % (n) | 89 (292) |
ACE inhibitor, % (n) | 66 (217) |
ARB, % (n) | 27 (117) |
Diuretics, % (n) | 77 (251) |
Statin, % (n) | 51 (167) |
OAC, % (n) | 44 (145) |
ASA, % (n) | 38 (124) |
Laboratory values | |
NTproBNP (ng/mL) | 1267 (509–2410) |
Hb (mmol/L) | 8.4 (7.9–9.0) |
Creatinine (umol/L) | 96 (78–119) |
eGFR (mL/min/1.73 m2) | 64 (47–81) |
Patient Population (N = 328) | |
---|---|
IEGM | |
Atrial sensing (ms) | 194 ± 50 |
Atrial pacing (ms) | 269 ± 59 |
Offset IEGM (ms) | 75 ± 25 |
Echocardiography | |
Atrial sensing (ms) | 75 ± 26 |
Atrial pacing (ms) | 148 ± 32 |
Offset Echo (ms) | 73 ± 18 |
Nominal AV Settings for Different Manufacturers | ||||
---|---|---|---|---|
Sensed AV Delay (ms) | Paced AV Delay (ms) | Offset (ms) | p-Value * | |
Biotronik | 150/120 | 190/160 | 40 | <0.001 |
Boston Scientific | 120 | 180 | 60 | <0.001 |
LivaNova | 125/80 | 190/145 | 65 | <0.001 |
Medtronic | 100 | 130 | 30 | <0.001 |
Abbott | 150 | 200 | 50 | <0.001 |
AV Offset Dispersion in Our Patient Cohort | ||||
AV Offset (ms) | Population (%) | |||
≤20 | 0.6 | |||
21–40 | 3.0 | |||
41–60 | 28.7 | |||
61–80 | 46.6 | |||
81–100 | 18.6 | |||
101–120 | 1.5 | |||
121–140 | 0.3 | |||
>140 | 0.6 |
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Kloosterman, M.; Daniëls, F.; Roseboom, E.; Rienstra, M.; Maass, A.H. Cardiac Resynchronization Therapy beyond Nominal Settings: An IEGM-Based Approach for Paced and Sensed Atrioventricular Delay Offset Optimization in Daily Clinical Practice. J. Clin. Med. 2023, 12, 4138. https://doi.org/10.3390/jcm12124138
Kloosterman M, Daniëls F, Roseboom E, Rienstra M, Maass AH. Cardiac Resynchronization Therapy beyond Nominal Settings: An IEGM-Based Approach for Paced and Sensed Atrioventricular Delay Offset Optimization in Daily Clinical Practice. Journal of Clinical Medicine. 2023; 12(12):4138. https://doi.org/10.3390/jcm12124138
Chicago/Turabian StyleKloosterman, Mariëlle, Fenna Daniëls, Eva Roseboom, Michiel Rienstra, and Alexander H. Maass. 2023. "Cardiac Resynchronization Therapy beyond Nominal Settings: An IEGM-Based Approach for Paced and Sensed Atrioventricular Delay Offset Optimization in Daily Clinical Practice" Journal of Clinical Medicine 12, no. 12: 4138. https://doi.org/10.3390/jcm12124138