AV delay optimisation in LV only CRT: constant fusion pacing is easier in patients with first degree AV block
| Autor: | S Crisan, A. Ionac, Lucian Petrescu, C T Luca, E V Goanta, Cristian Mornos, D. Cozma, M A Lazar, C Vacarescu |
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| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
Fusion business.industry medicine.medical_treatment Cardiac resynchronization therapy First degree AV block medicine.disease First-degree atrioventricular block Internal medicine medicine Cardiology In patient PR interval Cardiology and Cardiovascular Medicine business Constant (mathematics) Ivabradine medicine.drug |
| Zdroj: | European Heart Journal. 41 |
| ISSN: | 1522-9645 0195-668X |
| Popis: | Background LV only pacing is non-inferior to BiV pacing, and recent publications showed that DDD CRT without RV lead is safe in patients with normal atrioventricular (AV) conduction, although there are no device algorithms available for fusion pacing and PR interval variability is understudied in this population. Purpose To analyse AV behaviour in patients with DDD CRT and the impact to effective fusion maintenance. Methods Consecutive patients with right atrium/left ventricle leads DDD CRT pacing system were included. Prospective data were collected at every 6 months follow-up visits: device interrogation, exercise test (ET), echocardiography. CRT assessment during ET analysed loss of LV capture with special focus on maintaining constant fusion pacing during exercise. We defined 2 groups of patients: longer PR interval patients (200–250 ms) and normal PR interval patients ( Results 55 patients (29 male) aged 62±11 y.o. were included, 36 patients with normal PR and 19 patients with longer PR. During follow-up (45±19 months), a total of 235 ETs were performed with mean exercise load 118±35 watts. In the normal PR group, 14 patients (39%) had inadequate pacing or loss of LV capture during ET due to physiological shortening of PR interval vs. 4 patients (21%) in the longer PR group. Loss of LV capture by exceeding maximum tracking rate (MTR) was noted in 6 patients (17%) with normal PR vs. 2 patients (11%) with long PR. Post ET device optimisation included: reprogramming rate adaptive AV interval (23±8 ms decrease in normal PR patients vs. 12±7 ms in longer PR patients, p Conclusions A lower rate of optimisations after ET was needed in patients with a slightly longer AV conduction to achieve stability of fusion pacing DDD CRT, without device algorithms. Larger studies are needed to assess AV conduction variability and the benefits of fusion pacing CRT in patients with longer PR interval. Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): University of Medicine and Pharmacy “Victor Babes”, Timisoara; Timisoara Institute of Cardiovascular Diseases |
| Databáze: | OpenAIRE |
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