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Title: Programming Cardiac Resynchronization Therapy for Electrical Synchrony: Reaching Beyond Left Bundle Branch Block and Left Ventricular Activation Delay.
Austin Authors: Varma, Niraj;O'Donnell, David ;Bassiouny, Mohammed;Ritter, Philippe;Pappone, Carlo;Mangual, Jan;Cantillon, Daniel;Badie, Nima;Thibault, Bernard;Wisnoskey, Brian
Affiliation: Cleveland Clinic, Cleveland, OH
University Hospital of Bordeaux, Pessac, France
Department of Electrophysiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
Abbott, Sylmar, CA
Electrophysiology Service, Montreal Heart Institute, Montreal, Canada
Issue Date: 6-Feb-2018
Date: 2018-02-06
Publication information: Journal of the American Heart Association 2018; 7(3): e007489
Abstract: QRS narrowing following cardiac resynchronization therapy with biventricular (BiV) or left ventricular (LV) pacing is likely affected by patient-specific conduction characteristics (PR, qLV, LV-paced propagation interval), making a universal programming strategy likely ineffective. We tested these factors using a novel, device-based algorithm (SyncAV) that automatically adjusts paced atrioventricular delay (default or programmable offset) according to intrinsic atrioventricular conduction. Seventy-five patients undergoing cardiac resynchronization therapy (age 66±11 years; 65% male; 32% with ischemic cardiomyopathy; LV ejection fraction 28±8%; QRS duration 162±16 ms) with intact atrioventricular conduction (PR interval 194±34, range 128-300 ms), left bundle branch block, and optimized LV lead position were studied at implant. QRS duration (QRSd) reduction was compared for the following pacing configurations: nominal simultaneous BiV (Mode I: paced/sensed atrioventricular delay=140/110 ms), BiV+SyncAV with 50 ms offset (Mode II), BiV+SyncAV with offset that minimized QRSd (Mode III), or LV-only pacing+SyncAV with 50 ms offset (Mode IV). The intrinsic QRSd (162±16 ms) was reduced to 142±17 ms (-11.8%) by Mode I, 136±14 ms (-15.6%) by Mode IV, and 132±13 ms (-17.8%) by Mode II. Mode III yielded the shortest overall QRSd (123±12 ms, -23.9% [P<0.001 versus all modes]) and was the only configuration without QRSd prolongation in any patient. QRS narrowing occurred regardless of QRSd, PR, or LV-paced intervals, or underlying ischemic disease. Post-implant electrical optimization in already well-selected patients with left bundle branch block and optimized LV lead position is facilitated by patient-tailored BiV pacing adjusted to intrinsic atrioventricular timing using an automatic device-based algorithm.
DOI: 10.1161/JAHA.117.007489
Journal: Journal of the American Heart Association
PubMed URL: 29432133
Type: Journal Article
Subjects: cardiac resynchronization therapy
left bundle branch block
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