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AV interval optimization using pressure volume loops in dual chamber pacemaker patients with maintained systolic left

Frank Eberhardt1, Thorsten Hanke, Joern Fitschen

  • 1Medical Clinic II, University of Luebeck, Luebeck, Germany. eberhardt@evkk.de

Clinical Research in Cardiology : Official Journal of the German Cardiac Society
|March 10, 2012
PubMed

Insights

Optimizing the atrioventricular (AV) interval in dual-chamber pacemaker patients with preserved left ventricular function significantly improves hemodynamic performance. This optimization yields substantial gains in stroke work and reduces systolic dyssynchrony, even in patients with long-term pacing.

Area of Science:

  • Cardiology
  • Biomedical Engineering
  • Medical Device Optimization

Background:

  • Atrioventricular (AV) interval optimization is often overlooked in dual-chamber pacemaker patients with preserved left ventricular (LV) function due to time constraints.
  • Consequently, most patients remain on their default AV interval settings.

Purpose of the Study:

  • To precisely measure the hemodynamic benefits of AV interval optimization in patients with chronic dual-chamber pacing and maintained LV function.
  • To assess the impact of AV interval optimization on stroke work and systolic dyssynchrony.

Main Methods:

  • Nineteen patients with chronic dual-chamber pacing and ejection fraction >45% underwent invasive hemodynamic assessment using a pressure-volume catheter.
  • The AV interval was systematically adjusted in 10 ms increments from 80 to 300 ms, with pressure-volume loops recorded during breath-holds.

Main Results:

  • AV interval optimization resulted in an average improvement in stroke work of 935 ± 760 mmHg/ml (14 ± 9% increase; p < 0.001).
  • A 10 ms change in AV interval altered average stroke work by 207 ± 162 mmHg/ml.
  • Optimization also led to significant improvements in systolic dyssynchrony indices (p = 0.01).

Conclusions:

  • The hemodynamic improvements achieved through AV interval optimization are comparable to those seen in cardiac resynchronization therapy for certain parameters.
  • The benefits of AV interval optimization are evident even in patients who have been receiving pacing for several years.
Abstract

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