Dynamic atrioventricular delay programming improves ventricular electrical synchronization as evaluated by 3D vectorcardiography

Elien B Engels, Bernard Thibault, Jan Mangual, Nima Badie, Luke C McSpadden, Leonardo Calò, Philippe Ritter, Carlo Pappone, Kerstin Bode, Niraj Varma, Frits W Prinzen

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Optimal timing of the atrioventricular delay in cardiac resynchronization therapy (CRT) can improve synchrony in patients suffering from heart failure. The purpose of this study was to evaluate the impact of SyncAV™ on electrical synchrony as measured by vectorcardiography (VCG) derived QRS metrics during bi-ventricular (BiV) pacing.

METHODS: Patients implanted with a cardiac resynchronization therapy (CRT) device and quadripolar left ventricular (LV) lead underwent 12‑lead ECG recordings. VCG metrics, including QRS duration (QRSd) and area, were derived from the ECG by a blinded observer during: intrinsic conduction, BiV with nominal atrioventricular delays (BiV Nominal), and BiV with SyncAV programmed to the optimal offset achieving maximal synchronization (BiV + SyncAV Opt).

RESULTS: One hundred patients (71% male, 40% ischemic, 65% LBBB, 32 ± 9% ejection fraction) completed VCG assessment. QRSd during intrinsic conduction (166 ± 25 ms) was narrowed successively by BiV Nominal (137 ± 23 ms, p < .05 vs. intrinsic) and BiV + SyncAV Opt (122 ± 22 ms, p < .05 vs. BiV Nominal). Likewise, 3D QRS area during intrinsic conduction (90 ± 42 mV ∗ ms) was reduced by BiV Nominal (65 ± 39 mV ∗ ms, p < .05 vs. intrinsic) and further by BiV + SyncAV Opt (53 ± 30 mV ∗ ms, p = .06 vs. BiV Nominal).

CONCLUSION: With VCG-based, patient-specific optimization of the programmable offset, SyncAV reduced electrical dyssynchrony beyond conventional CRT.

Original languageEnglish
Pages (from-to)1-6
Number of pages6
JournalJournal of Electrocardiology
Volume58
DOIs
Publication statusPublished - Nov 5 2019

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    Engels, E. B., Thibault, B., Mangual, J., Badie, N., McSpadden, L. C., Calò, L., Ritter, P., Pappone, C., Bode, K., Varma, N., & Prinzen, F. W. (2019). Dynamic atrioventricular delay programming improves ventricular electrical synchronization as evaluated by 3D vectorcardiography. Journal of Electrocardiology, 58, 1-6. https://doi.org/10.1016/j.jelectrocard.2019.09.026