Interventricular delay interval optimization in cardiac resynchronization therapy guided by echocardiography versus...

Area of Science:

• Cardiology
• Biomedical Engineering
• Medical Devices

Background:

• Cardiac resynchronization therapy (CRT) devices allow hemodynamic optimization through biventricular (VV) pacing and atrioventricular (AV) interval adjustments.
• The utility of QRS width as a guide for echocardiography-based device programming remains undefined.

Purpose of the Study:

• To investigate the relationship between VV-interval optimization guided by echocardiography and by QRS interval width.
• To assess the concordance between two methods for optimizing VV delay in CRT patients.

Main Methods:

• One hundred six patients with CRT devices underwent echocardiographic optimization of AV and VV delays.
• VV optimization involved measuring aortic velocity time integral at various pacing settings.
• Electrocardiogram (ECG) QRS duration was measured to define the ECG-optimized VV interval.

Main Results:

• Significant concordance (kappa = 0.69, p <0.001) was observed between echocardiographic- and ECG-optimized VV intervals.
• Echocardiographic optimization resulted in various VV settings, including simultaneous, LV pre-excitation, and RV pre-excitation.
• The shortest QRS interval on ECG correlated well with echocardiographic findings.

Conclusions:

• A significant concordance exists between VV programming based on shortest QRS interval via 12-lead ECG and echocardiographic-guided optimization.
• A combined ECG and echocardiographic approach may offer a more time-efficient method for CRT device programming.