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Benefits of Cardiac Resynchronization Therapy in an Asynchronous Heart Failure Model Induced by Left Bundle Branch Ablation and Rapid Pacing

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Atrioventricular delay programming in cardiac resynchronization therapy devices: fixed or adaptive? A randomized

Melanie Schueler¹, Frederik Voss, Alexander Bauer

¹Department of Cardiology, University of Heidelberg, Heidelberg, Germany. melanie.schueler@med.uni-heidelberg.de

Journal of Electrocardiology

|June 26, 2012

Summary

Rate-adaptive atrioventricular delay (AVD) programming in cardiac resynchronization therapy may improve exercise hemodynamics compared to fixed-AVD. Further research is needed to confirm these findings for optimal patient outcomes.

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Area of Science:

Cardiology
Biomedical Engineering

Background:

Cardiac resynchronization therapy (CRT) devices are typically programmed using fixed atrioventricular delays (AVD) determined at rest.
The effectiveness of fixed-AVD for optimizing hemodynamics during exercise remains uncertain.

Purpose of the Study:

To compare the effects of fixed-AVD versus rate-adaptive AVD on exercise hemodynamics in CRT patients.

Main Methods:

100 patients with CRT systems in sinus rhythm were randomized to either fixed-AVD or adaptive-AVD programming.
Patients underwent bicycle ergometry with noninvasive hemodynamic monitoring.
Stroke volume, cardiac output, and cardiac index were measured at rest and peak exercise using electrical velocimetry.

Main Results:

No significant differences in baseline characteristics or hemodynamics were observed between the groups.
Patients with adaptive-AVD showed a trend towards improved stroke volume, cardiac output, and cardiac index during peak exercise.

Conclusions:

A trend towards better exercise hemodynamics with adaptive-AVD suggests potential benefits.
A larger, randomized follow-up study with clinical endpoints is warranted to validate these findings.