Optimisation of cardiac resynchronization therapy in clinical practice during exercise

Area of Science:

• Cardiology
• Biomedical Engineering

Background:

• Cardiac resynchronization therapy (CRT) improves cardiac function, but patient response varies.
• Optimal atrioventricular (AV) delay is crucial for effective CRT, potentially differing between rest and exercise.
• Non-invasive hemodynamic monitoring offers a method to personalize CRT parameters.

Purpose of the Study:

• To assess the feasibility of using Nexfin (finger plethysmography) for optimizing AV delay during exercise.
• To determine if optimizing AV delay during exercise improves stroke volume (SV) in CRT patients.
• To investigate the relationship between heart rate (HR) and optimal AV delay during exercise.

Main Methods:

• Thirty-one CRT patients were enrolled.
• Stroke volume (SV) was measured using Nexfin at rest and during exercise across various AV delays.
• Least squares estimates (LSE) determined optimal AV delay using patient-specific data.

Main Results:

• Nexfin enabled AV delay optimization during exercise.
• Optimized AV delay resulted in a 10% improvement in stroke volume (SV).
• The relationship between heart rate (HR) and optimal AV delay was patient-specific.

Conclusions:

• Nexfin facilitates AV delay optimization during exercise, potentially increasing SV by 10%.
• A significant number of patients benefited from adjusted AV delays during exercise.
• Personalized AV delay optimization during exercise may enhance CRT outcomes.