Method of atrioventricular programming in atrial flutter in patients with biventricular pacemaker

Area of Science:

• Cardiology
• Biomedical Engineering
• Medical Devices

Background:

• Atrial flutter frequently exacerbates congestive heart failure (CHF).
• Current pacemakers often switch to non-tracking modes during atrial tachycardia.
• Biventricular pacemakers are used for CHF management.

Observation:

• A novel atrioventricular (AV) pacemaker programming method was applied to four symptomatic patients with atrial flutter and CHF post-biventricular pacemaker implantation.
• Programming involved adjusting AV delay and postventricular atrial refractory period (PVARP) to sense specific atrial flutter beats.
• Mode switch was deactivated, and rate limits were set, with adjustments guided by mitral inflow Doppler to optimize atrial velocity.

Findings:

• All patients showed improved aortic ejection duration and peak ejection velocity after AV optimization.
• No changes in P and QRS relationship were observed on ECGs up to 8 months post-optimization.
• All patients experienced improvement in congestive heart failure symptoms following pacemaker optimization.

Implications:

• This echo-guided programming strategy can achieve atrial mechanical contribution to cardiac output in CHF patients with atrial flutter and biventricular pacemakers.
• Optimizing AV delay and PVARP offers a method to improve hemodynamics and symptoms in this patient population.
• This approach may enhance the efficacy of biventricular pacing in managing complex cardiac conditions.