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Open Access 01-06-2015 | Original Investigation

Feasibility of a novel atrioventricular delay optimization method using transmitral and pulmonary venous flow in patients with sequential ventricular pacing or cardiac resynchronization therapy

Authors: Kenzo Fukuhara, Hiroyuki Okura, Terumasa Koyama, Teruyoshi Kume, Yoji Neishi, Akihiro Hayashida, Kiyoshi Yoshida

Published in: Journal of Echocardiography | Issue 2/2015

Abstract

Background

Although several echo-Doppler methods were proposed to optimize atrioventricular (AV) delay in patients with sequential ventricular pacing, “echo-guided” AV optimization has not been widely adopted clinically. A combination of trasmitral flow (TMF) and pulmonary venous flow (PVF) measurements may be beneficial to further optimize AV delay to achieve better cardiac function. The aim of this study was to assess the feasibility and usefulness of AV delay optimization by combined use of TMF and PVF.

Methods

A total of 32 patients after sequential ventricular pacemaker implantation were enrolled and studied. The optimal AV delay was defined as the timing to minimize the duration between PVF reversal (a) wave and the duration of the “A” wave of TMF. Stroke volume was measured at the “optimized” AV delay (AVD_OPT) and was compared with that obtained at shorter (AVD_OPT − 50 ms) and longer (AVD_OPT + 50 ms) AV delays.

Results

AV optimization was feasible in 27 of 32 patients (87 %). Stroke volume at AVD_OPT was significantly higher than that at shorter or longer AV delay (63 ± 18 ml vs. 57 ± 15 ml vs. 56 ± 16 ml, P = 0.001).

Conclusions

AV delay optimization using TMF and PV flow was feasible. Usefulness of this method requires further investigation with a larger study population.

Frielingsdorf J, Gerber AE, Hess OM. Importance of maintained atrio-ventricular synchrony in patients with pacemakers. Eur Heart J. 1994;15:1431–40.PubMed

Guardigli G, Ansani L, Percoco GF, et al. AV delay optimization and management of DDD paced patients with dilated cardiomyopathy. Pacing Clin Electrophysiol. 1994;17:1984–8.PubMedCrossRef

Pearson AC, Janosik DL, Redd RR, et al. Doppler echocardiographic assessment of the effect of varying atrioventricular delay and pacemaker mode on left ventricular filling. Am Heart J. 1988;115:611–21.PubMedCrossRef

Toda N, Ishikawa T, Nozawa N, Kobayashi I, et al. Doppler index and plasma level of atrial natriuretic hormone are improved by optimizing atrioventricular delay in atrioventricular block patients with implanted DDD pacemakers. Pacing Clin Electrophysiol. 2001;24:1660–3.PubMedCrossRef

Daubert JC, Saxon L, Adamson PB, et al. 2012 EHRA/HRS expert consensus statement on cardiac resynchronization therapy in heart failure: implant and follow-up recommendations and management. Europace. 2012;14:1236–86.PubMedCrossRef

Whinnett ZI, Davies JE, Willson K, et al. Haemodynamic effects of changes in atrioventricular and interventricular delay in cardiac resynchronisation therapy show a consistent pattern: analysis of shape, magnitude and relative importance of atrioventricular and interventricular delay. Heart. 2006;92:1628–34.PubMedCentralPubMedCrossRef

Tei C, Nishimura RA, Seward JB, et al. Noninvasive Doppler-derived myocardial performance index: correlation with simultaneous measurements of cardiac catheterization measurements. J Am Soc Echocardiogr. 1997;10:169–78.PubMedCrossRef

Gola A, Pozzoli M, Capomolla S, et al. Comparison of Doppler echocardiography with thermodilution for assessing cardiac output in advanced congestive heart failure. Am J Cardiol. 1996;78:708–12.PubMedCrossRef

Ishikawa T, Sumita S, Kimura K, et al. Prediction of optimal atrioventricular delay in patients with implanted DDD pacemakers. Pacing Clin Electrophysiol. 1999;22:1365–71.PubMedCrossRef

10.

Ritter P, Padeletti L, Gillio-Meina L, et al. Determination of the optimal atrioventricular delay in DDD pacing. Comparison between echo and peak endocardial acceleration measurements. Europace. 1999;1:126–30.PubMedCrossRef

11.

Meluzin J, Novak M, Mullerova J, et al. A fast and simple echocardiographic method of determination of the optimal atrioventricular delay in patients after biventricular stimulation. Pacing Clin Electrophysiol. 2004;27:58–64.PubMedCrossRef

12.

Jansen AH, Bracke FA, van Dantzig JM, et al. Correlation of echo-Doppler optimization of atrioventricular delay in cardiac resynchronization therapy with invasive hemodynamics in patients with heart failure secondary to ischemic or idiopathic dilated cardiomyopathy. Am J Cardiol. 2006;97:552–7.PubMedCrossRef

13.

Morales MA, Startari U, Panchetti L, et al. Atrioventricular delay optimization by doppler-derived left ventricular dP/dt improves 6-month outcome of resynchronized patients. Pacing Clin Electrophysiol. 2006;29:564–8.PubMedCrossRef

14.

Gervais R, Leclercq C, Shankar A, et al. Surface electrocardiogram to predict outcome in candidates for cardiac resynchronization therapy: a sub-analysis of the CARE-HF trial. Eur J Heart Fail. 2009;11:699–705.PubMedCrossRef

15.

Khaykin Y, Exner D, Birnie D, et al. Adjusting the timing of left-ventricular pacing using electrocardiogram and device electrograms. Europace. 2011;13:1464–70.PubMedCrossRef

16.

Kamdar R, Frain E, Warburton F, et al. A prospective comparison of echocardiography and device algorithms for atrioventricular and interventricular interval optimization in cardiac resynchronization therapy. Europace. 2010;12:84–91.PubMedCrossRef

17.

Ishikawa T, Sugano T, Sumita S, et al. Optimal atrioventricular delay setting determined by evoked QT interval in patients with implanted stimulus-T-driven DDDR pacemakers. Europace. 2001;3:46–51.PubMedCrossRef

18.

Ellenbogen KA, Gold MR, Meyer TE, et al. Primary results from the smart delay determined AV optimization: a comparison to other AV delay methods used in cardiac resynchronization therapy (SMART-AV) trial: a randomized trial comparing empirical, echocardiography-guided, and algorithmic atrioventricular delay programming in cardiac resynchronization therapy. Circulation. 2010;122:2660–8.PubMedCrossRef

19.

Sawhney NS, Waggoner AD, Garhwal S, et al. Randomized prospective trial of atrioventricular delay programming for cardiac resynchronization therapy. Heart Rhythm. 2004;1:562–7.PubMedCrossRef

20.

Antonini L, Auriti A, Pasceri V, et al. Optimization of the atrioventricular delay in sequential and biventricular pacing: physiological bases, critical review, and new purposes. Europace. 2012;14:929–38.PubMedCrossRef

21.

Rossvoll O, Hatle LK. Pulmonary venous flow velocities recorded by transthoracic Doppler ultrasound: relation to left ventricular diastolic pressures. J Am Coll Cardiol. 1993;21:1687–96.PubMedCrossRef

22.

Ritter P, Dib JC, Lelievre T, et al. Quick determination of the optimal AV delay at rest in patients paced in DDD mode for complete AV block. Eur JCPE. 1994;4:163.

23.

Kedia N, Ng K, Apperson-Hansen C, et al. Usefulness of atrioventricular delay optimization using Doppler assessment of mitral inflow in patients undergoing cardiac resynchronization therapy. Am J Cardiol. 2006;98:780–5.PubMedCrossRef

24.

Gorcsan J 3rd, Abraham T, Agler DA, et al. Echocardiography for cardiac resynchronization therapy: recommendations for performance and reporting—a report from the American Society of Echocardiography Dyssynchrony Writing Group endorsed by the Heart Rhythm Society. J Am Soc Echocardiogr. 2008;21:191–213.PubMedCrossRef

25.

Ishikawa T, Sumita S, Kimura K, et al. Critical PQ interval for the appearance of diastolic mitral regurgitation and optimal PQ interval in patients implanted with DDD pacemakers. Pacing Clin Electrophysiol. 1994;17:1989–94.PubMedCrossRef

26.

Izumi C, Yoshida K, Akasaka T, et al. Improved visualization of pulmonary venous flow Doppler signal by intravenous injection of sonicated albumin. Am J Cardiol. 1996;78:598–600.PubMedCrossRef

27.

Okura H, Yoshida K, Akasaka T, et al. Improved transvalvular continuous-wave Doppler signal intensity after intravenous albunex injection in patients with prosthetic aortic valves. J Am Soc Echocardiogr. 1997;10:608–12.PubMedCrossRef

28.

Okura H, Fuyuki H, Kubo T, et al. Noninvasive diagnosis of ischemic and nonischemic cardiomyopathy using coronary flow velocity measurements of the left anterior descending coronary artery by transthoracic Doppler echocardiography. J Am Soc Echocardiogr. 2006;19:552–8.PubMedCrossRef

29.

Okura H, Takada Y, Yamabe A, et al. Prevalence and correlates of physiological valvular regurgitation in healthy subjects. Circ J. 2011;75:2699–704.PubMedCrossRef

Title: Feasibility of a novel atrioventricular delay optimization method using transmitral and pulmonary venous flow in patients with sequential ventricular pacing or cardiac resynchronization therapy
Authors: Kenzo Fukuhara
Hiroyuki Okura
Terumasa Koyama
Teruyoshi Kume
Yoji Neishi
Akihiro Hayashida
Kiyoshi Yoshida
Publication date: 01-06-2015
Publisher: Springer Japan
Published in: Journal of Echocardiography / Issue 2/2015
Print ISSN: 1349-0222
Electronic ISSN: 1880-344X
DOI: https://doi.org/10.1007/s12574-014-0237-x

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Feasibility of a novel atrioventricular delay optimization method using transmitral and pulmonary venous flow in patients with sequential ventricular pacing or cardiac resynchronization therapy

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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