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Optimal programming of the atrioventricular delay using the phonocardiogram.

Yuko Miki¹, Toshiyuki Ishikawa, Kohei Matsushita

¹Department of Medical Science and Cardiorenal Medicine, Yokohama City University School of Medicine, Yokohama, Japan. t056044c@yokohama-cu.ac.jp

Pacing and Clinical Electrophysiology : PACE

|March 3, 2009

Summary

This summary is machine-generated.

Phonocardiography (PCG) can accurately predict the optimal atrioventricular (AV) delay for cardiac resynchronization therapy (CRT). This non-invasive method correlates well with echocardiography, offering a reliable alternative for optimizing AV delay.

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Area of Science:

Cardiology
Biomedical Engineering
Medical Devices

Background:

Cardiac resynchronization therapy (CRT) and dual-chamber pacemakers are crucial for managing heart conditions.
Optimizing atrioventricular (AV) delay is essential for maximizing the efficacy of these devices.
Current methods for AV delay optimization, such as echocardiography, can be time-consuming and operator-dependent.

Purpose of the Study:

To investigate the potential of phonocardiography (PCG) for predicting the optimal atrioventricular (AV) delay.
To establish a correlation between PCG-derived parameters and echocardiography-based optimal AV delay.
To explore PCG as a non-invasive tool for AV delay optimization in patients with pacemakers and CRT systems.

Main Methods:

Studied 12 cardiac resynchronization therapy (CRT) recipients and 8 dual-chamber pacemaker recipients with AV block and normal left ventricular (LV) function.
Recorded the first heart sound (S1) amplitude using PCG and measured the LV outflow tract (OT) time-velocity integral (TVI) via Doppler echocardiography.
Systematically varied AV delay from 60 ms to 240 ms and analyzed the relationship between S1 amplitude and AV delay, comparing with echocardiographic optimization (Ishikawa's method).

Main Results:

An S-shaped curve characterized the relationship between S1 amplitude and AV delay.
The AV delay at the inflection point of the S-shaped curve (161.2 ± 19.5 ms) strongly correlated with the echocardiographically determined optimal AV delay (148.3 ± 16.9 ms; r = 0.83, P < 0.001).
PCG successfully determined optimal AV delay in two CRT patients for whom echocardiography was inconclusive.

Conclusions:

Phonocardiography demonstrates a significant correlation with echocardiography in determining optimal AV delay.
PCG offers a promising, non-invasive method for optimizing AV delay in patients requiring pacemakers or CRT.
This approach could enhance the efficiency and effectiveness of device implantation and programming.