Contribution to the V-V interval optimization in patients with cardiac resynchronization therapy.

Area of Science:

• Cardiology
• Biomedical Engineering
• Medical Devices

Background:

• Optimizing biventricular pacing is crucial for patients with heart failure and left bundle branch block.
• Current methods for determining the optimal atrioventricular delay may not fully account for individual electromechanical properties.

Purpose of the Study:

• To propose and validate a novel procedure for predicting the optimal left and right ventricular pacing interval delay (V-V interval).
• To assess the impact of the proposed method on cardiac output and left ventricular performance.

Main Methods:

• Two methods (A and B) for predicting the optimal V-V interval were tested in 16 patients undergoing biventricular pacing.
• Method A utilized the electromechanical delay between left and right ventricular segments.
• Echocardiography and right-sided heart catheterization were used for validation.

Main Results:

• The predicted optimal V-V interval using Method A (POVV-A) resulted in significantly higher cardiac output (4.6 l/min) compared to adjusted intervals and Method B (4.4 l/min).
• Left ventricular dP/dt was also significantly improved with POVV-A (818 mmHg/s) compared to other tested intervals and Method B (727 mmHg/s).
• The time difference in myocardial deformation onset effectively identified the optimal V-V interval.

Conclusions:

• The proposed method, based on the time difference in myocardial deformation, accurately identifies the optimal V-V interval for biventricular pacing.
• This approach significantly improves left ventricular performance and cardiac output in patients with heart failure and left bundle branch block.