Programming an optimal atrioventricular interval in a dual chamber pacemaker regional population

Area of Science:

• Cardiology
• Biomedical Engineering

Background:

• Dual chamber pacemakers (DDDR) require optimized atrioventricular (AV) delay for improved cardiac performance.
• Nominal AV delay settings are often suboptimal for patients with AV conduction disorders.

Purpose of the Study:

• To present a simplified method for optimizing AV delay in DDDR pacemaker patients.
• To evaluate the impact of adjusted AV delay on cardiac function using electrocardiogram (ECG) programming.

Main Methods:

• 55 patients with complete or second-degree AV block received DDDR pacemakers.
• Optimal AV delay was determined by adding 95 ms to the intrinsic P wave duration on the programming ECG.
• Left ventricular systolic and diastolic function were assessed via Doppler echocardiography at nominal and optimal AV delay.

Main Results:

• Adjusted AV delay significantly decreased end-systolic volume and increased left ventricle ejection fraction.
• Isovolumic relaxation time was reduced, indicating improved diastolic function.
• Left ventricular end-diastolic volume and diastolic parameters (E wave, A wave, E/A ratio) showed no significant changes.

Conclusions:

• Programmer ECG-guided AV delay adjustment is a simple and effective method for optimizing ventricular pacing.
• This technique offers hemodynamic improvement in patients with DDDR pacemakers.
• The method provides a valuable tool for follow-up device programming.