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Closed Chest Biventricular Pressure-Volume Loop Recordings with Admittance Catheters in a Porcine Model

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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

Summary

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.

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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.