Effects of AV Delay and VV Delay on Left Atrial Pressure and Waveform in Ambulant Heart Failure Patients: Insights into CRT Optimization.
Background: We hypothesized that left atrial pressure (LAP) obtained by a permanent implantable sensor is sensitive to changes in cardiac resynchronization therapy (CRT) settings and could guide CRT optimization to improve the response rate. We investigated the effect of CRT optimization on LAP and...
| Publicado en: | Pacing & Clinical Electrophysiology Vol. 37; no. 7; pp. 810 - 820 |
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| Autores principales: | , , , , , , , , |
| Formato: | research tables/charts tracings Journal Article |
| Publicado: |
Wiley-Blackwell
Jul2014
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=103788729&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 103788729 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 01478389 4F8 jtl: Pacing & Clinical Electrophysiology issn: 01478389 maglogo: Y pubinfo: dt: Jul2014 vid: 37 iid: 7 pid: 480 pub: Wiley-Blackwell place: Malden, Massachusetts artinfo: ui: 103788729 102088128 10.1111/pace.12362 NLM24502608 103788729 ppf: 810 ppct: 10 formats: fmt: @attributes: type: P tig: atl: Effects of AV Delay and VV Delay on Left Atrial Pressure and Waveform in Ambulant Heart Failure Patients: Insights into CRT Optimization. aug: au: Chan, W. Y. Wandy Blomqvist, Andreas Melton, Iain C. NorÉN, Kjell Crozier, Ian G. Benser, Michael E. Eigler, Neal L. Gutfinger, Dan Troughton, Richard W. affil: Cardiology Department, Christchurch Hospital, Christchurch, New Zealand sug: subj: Heart Failure Therapy Cardiac Resynchronization Therapy Methods Atrial Pressure Physiology Waveforms Human Echocardiography Methods Descriptive Statistics Funding Source Prospective Studies New Zealand Middle Age Aged Data Analysis Software Analysis of Variance Pilot Studies Middle Aged: 45-64 years Aged: 65+ years ab: Background: We hypothesized that left atrial pressure (LAP) obtained by a permanent implantable sensor is sensitive to changes in cardiac resynchronization therapy (CRT) settings and could guide CRT optimization to improve the response rate. We investigated the effect of CRT optimization on LAP and its waveform parameters in ambulant heart failure (HF) patients. Methods: CRT optimization was performed in eight ambulant HF patients, using echocardiography as reference. LAP waveform was acquired at each of eight atrioventricular (AV) intervals and five interventricular (VV) intervals. Selected waveform parameters were also evaluated for their sensitivity to CRT changes and agreement with echocardiography-guided optimal settings. Results: Optimal AV and VV intervals varied considerably between patients. All patients exhibited significant changes in waveform morphology with AV optimization. Optimal AV delay determined from echocardiography ranged between 140 ms and 225 ms. Mean LAP tended to be lower at optimal setting 14 ± 3 mmHg compared to shorter (<100 ms) or longer (>160 ms) AV settings (P = 0.16). There were clear trends to smaller peak a-wave (P = 0.11) and gentler positive a-slope (P = 0.15) and positive v-slope (P = 0.09) with longer AV delays. Mean LAP and negative v-wave slope correlated well with echo-guided optimal setting, r = 0.91 (P = 0.001) and 0.79 (P = 0.03), respectively. No significant effects on LAP or waveform were seen during VV optimization. Conclusions: LAP and its waveform changes considerably with AV optimization. There is good agreement between echo-guided optimal setting and LAP. LAP could provide an objective guide to CRT optimization. pubtype: Academic Journal doctype: research tables/charts tracings Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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