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Optimization of the atrioventricular delay in conduction system pacing

Giovanni Coluccia1, Gabriele Dell'Era2, Chiara Ghiglieno2

  • 1Cardiology Unit, "Card. G. Panico" Hospital, Tricase, Italy.

Journal of Cardiovascular Electrophysiology
|May 10, 2023
PubMed

Insights

An electrophysiology-guided method effectively programs sensed atrioventricular delay (sAVD) in conduction system pacing (CSP) patients. This method, using His-bundle or left bundle branch pacing, achieved over 70% concordance with echocardiogram optimization.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Medical Devices

Background:

  • Programming sensed atrioventricular delay (sAVD) in conduction system pacing (CSP) remains challenging.
  • Optimal sAVD programming varies based on His-bundle (HB) or left bundle branch (LBB) capture type.

Purpose of the Study:

  • To evaluate an electrophysiology (EP)-guided method for sAVD optimization.
  • To compare EP-guided sAVD optimization with echocardiogram-guided optimization in CSP patients.

Main Methods:

  • Patients undergoing HB or LBB pacing were enrolled.
  • EP-guided sAVD was determined by achieving a 150 ms PR interval on ECG using local electrogram intervals.
  • Echocardiogram-guided sAVD was identified using transmitral flow assessment via pulsed wave Doppler.

Main Results:

  • Seventy-one patients were included: 12 selective HB, 32 nonselective HB, and 27 LBB capture.
  • The overall concordance rate between EP-guided and echo-optimized sAVD was 71.8%.
  • No significant differences in concordance were observed across the different capture types.

Conclusions:

  • An optimal sAVD can be programmed in over 70% of CSP patients.
  • Simple electrogram intervals can guide sAVD programming to achieve a physiological PR interval on surface ECG.
Abstract

Keywords:
AV delay optimizationHis bundle pacingconduction system pacingleft bundle branch area pacing

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