Improvement of electrical synchrony in cardiac resynchronization therapy using dynamic atrioventricular delay
Fabian Schiedat1,2, Dejan Mijic3, Zana Karosiene4
1Department of Cardiology and Angiology at University Hospital Bergmannsheil Bochum of the Ruhr-University Bochum, Bochum, Germany.
Pacing and Clinical Electrophysiology : PACE
|September 29, 2021
Summary
Combining dynamic atrioventricular delay (SyncAV) and multipoint pacing (MPP) significantly improves cardiac resynchronization therapy (CRT) electrical synchrony. Patient-specific optimization of SyncAV with MPP yielded the greatest QRS duration reduction, regardless of implantation time.
Area of Science:
- Cardiology
- Biomedical Engineering
- Electrophysiology
Background:
- Cardiac resynchronization therapy (CRT) optimization is crucial but often time-consuming, limiting its clinical use.
- Novel algorithms like dynamic atrioventricular delay (SyncAV) and multipoint pacing (MPP) aim to simplify CRT optimization.
- This study investigates the acute effects of SyncAV and MPP on electrical synchrony in CRT patients.
Purpose of the Study:
- To evaluate the acute impact of SyncAV and MPP, individually and in combination, on electrical synchrony in CRT patients.
- To compare the effectiveness of different SyncAV and MPP configurations on QRS duration.
- To determine if the time since CRT device implantation influences the efficacy of these algorithms.
Main Methods:
- Prospective enrollment of patients with SyncAV and MPP enabled CRT devices.
- Blinded 12-lead electrocardiographic measurements of QRS duration under various pacing modes: intrinsic, BiV, MPP, BiVSyncAV (default and optimized), and MPPSyncAV (default and optimized).
- Comparison of QRS duration across different pacing configurations and between newly and chronically implanted devices.
Main Results:
- The combination of MPP with patient-specific optimized SyncAV (MPPSyncAVopt) resulted in the greatest reduction in QRS duration compared to intrinsic rhythm (-31.6%).
- MPPSyncAVopt achieved significantly shorter QRS duration than all other pacing configurations and the shortest QRS duration in every patient.
- No significant difference in QRS duration shortening was observed between newly and chronically implanted devices.
Conclusions:
- SyncAV and MPP effectively improve acute electrical synchrony in CRT patients.
- Combining patient-tailored SyncAV optimization with MPP provides the most significant improvement in electrical synchrony, measured by QRS duration.
- The benefits of combining SyncAV and MPP are independent of the time since CRT device implantation, offering a simplified approach to optimize CRT.
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