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Optimal atrioventricular delay in CRT patients can be approximated using surface electrocardiography and device
R Christopher Jones1, Tom Svinarich, Andrew Rubin
1Centennial Heart Cardiovascular Associates, Nashville, Tennessee, USA.
Journal of Cardiovascular Electrophysiology
|June 5, 2010
Summary
A simple electrocardiogram (ECG) method can approximate optimal atrioventricular (AV) delay settings for cardiac resynchronization therapy (CRT). This noninvasive approach aids in improving CRT outcomes by adjusting AV delay based on P-wave duration.
Area of Science:
- Cardiology
- Biomedical Engineering
- Medical Devices
Background:
- Optimizing atrioventricular (AV) delay is crucial for improving cardiac resynchronization therapy (CRT) outcomes.
- Previous research linked invasive interatrial conduction time to optimal AV delay (AVD) determined by echocardiography.
- This study explored predicting optimal AVD noninvasively using surface electrocardiograms (ECG).
Purpose of the Study:
- To investigate the noninvasive prediction of optimal atrioventricular (AV) delay (AVD) from surface electrocardiograms (ECG).
- To establish a simple ECG-based method for approximating echocardiographically determined optimal AVDs in CRT patients.
Main Methods:
- Determined optimal sensed (SAV) and paced (PAV) AVDs in 63 CRT patients using an iterative method with Doppler echocardiography.
- Measured ECG intervals from 5 leads and device telemetry during sinus rhythm and atrial pacing.
- Analyzed correlations between ECG intervals and echo-derived optimal AVDs.
Main Results:
- Optimal SAV (120 ± 30 ms) correlated with As-Pend (R = 0.69) and As-RVs (R = 0.45).
- Optimal PAV (172 ± 38 ms) correlated with Ap-Pend (R = 0.65) and Ap-RVs (R = 0.60).
- Regression analysis proposed pacing 30-40 ms after P-wave end for optimal AVD approximation.
Conclusions:
- A straightforward method using a 30-40 ms interval between P-wave end and ventricular pacing approximates optimal AV delays.
- This ECG-based approach offers a simpler alternative to echocardiography for AVD adjustment in CRT.
- The proposed method could lead to improved CRT outcomes through more accurate AVD programming.
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