Variation in optimal hemodynamic atrio-ventricular delay of biventricular pacing with different endocardial left...

Area of Science:

• Cardiology
• Biomedical Engineering
• Heart Failure Management

Background:

• Optimal atrioventricular (AV) delay is crucial for effective biventricular pacing (BiVP) in heart failure patients.
• The influence of left ventricular (LV) lead placement on the optimal AV delay during endocardial BiVP is not well understood.

Purpose of the Study:

• To assess if the optimal atrioventricular (AV) delay (AVopt) varies based on the left ventricular (LV) pacing site during endocardial biventricular pacing (BiVP).
• To compare the hemodynamic effectiveness of individualized AVopt with a fixed AV delay.

Main Methods:

• Assessed hemodynamic AVopt in 17 chronic heart failure patients undergoing endocardial LV lead implantation.
• Utilized a roving LV lead to evaluate AVopt at multiple sites (mid-lateral, mid-septal, best improvement, implant site).
• Compared AVopt to a fixed AV delay of 180 ms and right ventricular pacing (RVP).

Main Results:

• AVopt increased systolic blood pressure during BiVP compared to RVP (6 mmHg improvement).
• Individualized AVopt yielded greater hemodynamic improvement than a fixed AV delay (1 mmHg, p < .001).
• Significant variations in AVopt were observed between pacing sites within most patients (median 209 ms), though the hemodynamic impact was minimal (median loss 0.6 mmHg).

Conclusions:

• Different endocardial LV lead locations result in slightly varied optimal atrioventricular (AV) delays.
• Individualized AVopt is hemodynamically superior to a fixed AV delay.
• The hemodynamic consequences of using an AVopt from a different lead location are minor.