Maximizing efficiency of alternation algorithms for hemodynamic optimization of the av delay of cardiac resynchronization therapy.
During optimization of the atrioventricular (AV) delay of cardiac resynchronization therapy (CRT), it is not known exactly which windows of time around the transition are most informative for identification of the optimum. In 22 patients with CRT, we performed AV delay optimization using continuous...
| Publicado en: | Pacing & Clinical Electrophysiology Vol. 34; no. 2; pp. 217 - 226 |
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| Autores principales: | , , , , , , , , , , |
| Formato: | research tables/charts Journal Article |
| Publicado: |
Wiley-Blackwell
Feb2011
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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=104807047&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 104807047 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 01478389 4F8 jtl: Pacing & Clinical Electrophysiology issn: 01478389 maglogo: Y pubinfo: dt: Feb2011 vid: 34 iid: 2 pid: 480 pub: Wiley-Blackwell place: Malden, Massachusetts artinfo: ui: 104807047 57856821 10.1111/j.1540-8159.2010.02933.x NLM21029129 104807047 ppf: 217 ppct: 9 formats: fmt: @attributes: type: P tig: atl: Maximizing efficiency of alternation algorithms for hemodynamic optimization of the av delay of cardiac resynchronization therapy. aug: au: Whinnett ZI Nott G Davies JER Willson K Manisty CH Kanagaratnam P Peters NS Davies DW Hughes AD Mayet J Francis DP affil: International Centre for Circulatory Health, National Heart and Lung Institute, St Mary's Hospital and Imperial College, London, United Kingdom sug: subj: Cardiac Resynchronization Therapy Methods Atrioventricular Node Physiopathology Hemodynamics Time Factors Human Heart Conduction System Physiopathology Heart Failure Therapy Male Female Middle Age Aged Aged, 80 and Over Blood Pressure Descriptive Statistics Post Hoc Analysis Paired T-Tests Data Analysis Software Algorithms Funding Source Middle Aged: 45-64 years Aged: 65+ years Aged, 80 & over Male Female ab: During optimization of the atrioventricular (AV) delay of cardiac resynchronization therapy (CRT), it is not known exactly which windows of time around the transition are most informative for identification of the optimum. In 22 patients with CRT, we performed AV delay optimization using continuous noninvasive hemodynamics. We used signal-to-noise ratio to determine the most efficient averaging window location and width. We found that it is most efficient to position the averaging windows immediately before and immediately after the transition in AV delay. For example, skipping five beats after the transition decreases signal-to-noise ratio by 17.5% (P < 0.0001). Similarly, skipping five beats immediately before the transition reduces signal-to-noise ratio by 11.7% (P < 0.0001). The best choice of 'fixed' averaging window width was found to be six beats, with signal-to-noise ratio falling by, for example, 41% for a one-beat window (P = 0.0002). However, even better was to set the window width for each patient to match one respiratory cycle. We observed that the pre- and posttransition signal-to-noise ratio traces begin to diverge three beats after the transition in AV delay. We believe this represents the time taken for the peripheral response to pacing-induced changes in stroke volume to occur. The most efficient way to use alternating transitions for the hemodynamic optimization of CRT is to use an averaging window of one respiratory cycle, and not to skip any beats between the pretransition and posttransition averaging windows. (PACE 2011; 34:217-225) pubtype: Academic Journal doctype: research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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