Distinct impacts of heart rate and right atrial-pacing on left atrial mechanical activation and optimal AV delay in CRT.
Background: Controversy exists regarding how atrial activation mode and heart rate affect optimal atrioventricular (AV) delay in cardiac resynchronization therapy. We studied these questions using high-reproducibility hemodynamic and echocardiographic measurements.Methods: Twenty patients were hemod...
| Publicado en: | Pacing & Clinical Electrophysiology Vol. 41; no. 8; pp. 959 - 967 |
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| Autores principales: | , , , , , , , , , , , |
| Formato: | research tables/charts Journal Article |
| Publicado: |
Wiley-Blackwell
Aug2018
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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=131163509&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 131163509 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 01478389 4F8 jtl: Pacing & Clinical Electrophysiology issn: 01478389 maglogo: Y pubinfo: dt: Aug2018 vid: 41 iid: 8 pid: 480 pub: Wiley-Blackwell place: Malden, Massachusetts artinfo: ui: 131163509 131163509 131163509 10.1111/pace.13401 131163509 ppf: 959 ppct: 8 formats: fmt: @attributes: type: P tig: atl: Distinct impacts of heart rate and right atrial-pacing on left atrial mechanical activation and optimal AV delay in CRT. aug: au: Kyriacou, Andreas Rajkumar, Christopher A. Pabari, Punam A. Afzal Sohaib, S. M. Willson, Keith Peters, Nicholas S. B. Lim, Phang Kanagaratnam, Prapa Hughes, Alun D. Mayet, Jamil Whinnett, Zachary I. Francis, Darrel P. affil: Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK sug: subj: Heart Rate Evaluation Heart Atrium, Right Cardiac Pacing, Artificial Heart Atrium, Left Human Atrioventricular Node Physiology Heart Physiology Hemodynamics Electrocardiography Reproducibility of Results Cardiac Resynchronization Therapy Electrophysiology Heart Failure Diagnosis Descriptive Statistics Middle Age Male Middle Aged: 45-64 years Male ab: Background: Controversy exists regarding how atrial activation mode and heart rate affect optimal atrioventricular (AV) delay in cardiac resynchronization therapy. We studied these questions using high-reproducibility hemodynamic and echocardiographic measurements.Methods: Twenty patients were hemodynamically optimized using noninvasive beat-to-beat blood pressure at rest (62 ± 11 beats/min), during exercise (80 ± 6 beats/min), and at three atriallypaced rates: 5, 25, and 45 beats/min above rest, denoted as A paced,r + 5, A paced, r + 25, and A paced,r + 45, respectively. Left atrial myocardial motion and transmitral flow were timed echocardiographically.Results: During atrial sensing, raising heart rate shortened optimal AV delay by 25 ± 6ms (P < 0.001). During atrial pacing, raising heart rate from A paced,r+5 to A paced,r+25 shortened it by 16±6 ms; A paced,r+45 shortened it 17 ± 6 ms further (P<0.001).In comparison to atrial-sensed activation, atrial pacing lengthened optimal AV delay by 76±6 ms (P<0.0001) at rest, and at ~20 beats/min faster, by 85±7 ms(P<0.0001), 9±4 ms more (P = 0.017). Mechanically, atrial pacing delayed left atrial contraction by 63±5 ms at rest and by 73±5 ms (i.e.,by 10±5 ms more, P<0.05) at ~20 beats/min faster.Raising atrial rate by exercise advanced left atrial contraction by 7±2 ms (P=0.001). Raising it by atrial pacing did not (P=0.2).Conclusions: Hemodynamic optimal AV delay shortens with elevation of heart rate. It lengthens on switching from atrial-sensed to atrial-paced at the same rate, and echocardiography shows this sensed-paced difference in optima results from a sensed-paced difference in atrial electromechanical delay. The reason for the widening of the sensed-paced difference in AV optimum may be physiological stimuli (e.g.,adrenergic drive) advancing left atrial contraction during exercise but not with fast atrial pacing. pubtype: Academic Journal doctype: research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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