Atrioventricular interval optimization in the right atrial appendage and interatrial septum pacing: A comparison between echo and peak endocardial acceleration measurements

L. Padeletti, M. C. Porciani, P. Ritter, A. Michelucci, A. Colella, P. Pieragnoli, A. Costoli, C. Ciapetti, A. Sabini, G. Demarchi, L. Gillio-Meina, G. Gaggini, G. F. Gensini

Research output: Contribution to journalArticle

Abstract

Interatrial septum pacing (IASP) reduces interatrial conduction time and consequently may interfere with atrioventricular delay (AVD) optimization. We studied 14 patients with an implanted BEST Living system device able to measure peak endocardial acceleration (PEA) signal. The aims of our study were to compare the (1) optimal A VD (OAVD) in right atrial appendage pacing (RAAP) and IASP, and (2) OAVD derived by the PEA Signal versus OAVD derived by Echo/Doppler evaluation of the left ventricular filling time (LVFT) and cardiac output (CO). Measurements were performed in DDD VDD modes Eight patients (group A) had RAAP and six patients (group B) had IASP. In group A, OAVD measured by LVFT, CO, and PEA was 185 ± 23 ms, 177 ± 19 ms, and 192 ± 23 ms in DDD and 147 ± 19 ms, 135 ± 27 ms, and 146 ± 20 ms in VDD, respectively. OAVD measured by LVFT, CO, and PEA was significantly longer in DDD mode than in VDD (P <0.01, P <0.01, P <0.001). In group B, OAVD measured by LVFT, CO, and PEA was 116 ± 19 ms, 113 ± 10 ms, and 130 ± 30ms in DDD and 106 ± 16 ms, 96 ± 15 ms, and 108 ± 26 ms in VDD, respectively. No statistical differences were observed between DDD and VDD. Significant correlations between OAVDs PEA derived and OAVDS LVFT and CO derived were observed (r = 0.71, r = 0.69, respectively). When new techniques of atrial stimulation, as IASP, are used an OAVD shorter and similar in VDD and DDD has to be considered. The BEST Living system could provide a valid method to ensure, in every moment, the exact required OAVD to maximize atrial contribution to CO.

Original languageEnglish
Pages (from-to)1618-1622
Number of pages5
JournalPACE - Pacing and Clinical Electrophysiology
Volume23
Issue number11 I
Publication statusPublished - 2000

Keywords

  • AV delay optimization
  • Interatrial conduction time
  • Interatrial septum pacing

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    Padeletti, L., Porciani, M. C., Ritter, P., Michelucci, A., Colella, A., Pieragnoli, P., Costoli, A., Ciapetti, C., Sabini, A., Demarchi, G., Gillio-Meina, L., Gaggini, G., & Gensini, G. F. (2000). Atrioventricular interval optimization in the right atrial appendage and interatrial septum pacing: A comparison between echo and peak endocardial acceleration measurements. PACE - Pacing and Clinical Electrophysiology, 23(11 I), 1618-1622.