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A perspective on atrioventricular delay optimization in patients with a dual chamber pacemaker
Maria Cristina Porciani1, Fabio Fantini, Nicola Musilli
1Institute of Internal Medicine and Cardiology, University of Florence, Florence Vitatron Medical Italia, Bologna, Italy. c.porciani@dfc.unifi.it
Pacing and Clinical Electrophysiology : PACE
|March 11, 2004
Summary
Optimizing atrioventricular delay (AVD) in DDD pacemaker patients is crucial. Different methods (cardiac output, filling time, myocardial performance index) yield varied optimal AVDs, yet systolic and diastolic function remain similar, with MPI optimization offering balanced performance.
Area of Science:
- Cardiology
- Biomedical Engineering
- Echocardiography
Background:
- Atrioventricular delay (AVD) optimization is critical for patients with dual-chamber pacemakers (DDD PM).
- Echocardiography/Doppler is used to determine optimal AVD based on left ventricular filling time (FT) or cardiac output (CO).
- Myocardial performance index (MPI) has emerged as a potential metric for AVD optimization.
Purpose of the Study:
- To compare optimal AVDs derived from CO, FT, and MPI.
- To analyze systolic and diastolic performance at each optimized AVD.
Main Methods:
- Twenty-five DDD pacemaker patients with third-degree AV block underwent echo/Doppler AVD optimization.
- Optimal AVDs were identified by maximizing CO, FT, and minimizing MPI.
- Evaluated isovolumic contraction time (ICT), relaxation time (IRT), ejection time (ET), and their ratios (ICT/ET, IRT/ET).
Main Results:
- Optimal AVDs for CO, FT, and MPI differed significantly (148±36 ms, 116±34 ms, 127±33 ms, respectively).
- ICT/ET ratios were similar across all optimized AVDs.
- IRT/ET ratio was significantly shorter at MPI-optimized AVD compared to CO-optimized AVD.
Conclusions:
- Different methods yield different optimal AVDs for DDD pacemaker patients.
- Despite differing optimal AVDs, systolic and diastolic performance show similar results.
- MPI-optimized AVD achieves high cardiac output with favorable systolic and diastolic function.