Present devices for cardiac resynchronization therapy offer the possibility of tailoring the hemodynamic effect of biventricular pacing by optimization of the interventricular delay (VV) beyond atrioventricular (AV)-interval optimization. It was not yet defined whether a QRS width-based strategy may be a helpful tool for echocardiography for device programming. The aim of the study was to investigate the relation between VV-interval optimization guided by echocardiography and guided by QRS interval width. One hundred six patients with a cardiac resynchronization therapy device for > or =3 months were enrolled. All patients underwent echocardiographic AV and VV delay optimization. The AV interval was optimized according to the E wave-A wave (EA) interval and left ventricular filling time. At the optimal AV delay, VV optimization was performed by measuring the aortic velocity time integral at 5 different settings: simultaneous right and left ventricle output, left ventricle pre-excitation (left ventricle + 40 and 80 ms, respectively), and right ventricle pre-excitation (right ventricle + 40 and 80 ms, respectively). A 12-lead electrocardiogram was recorded and QRS duration was measured in the lead with the greatest QRS width. The electrocardiographic (ECG)-optimized VV interval was defined according to the narrowest achievable QRS interval among 5 VV intervals. The echocardiographic-optimized VV interval was left ventricle + 40 ms in 28 patients, left ventricle + 80 ms in 15 patients, simultaneous in 46 patients, right ventricle + 40 ms in 14 patients, and right ventricle + 80 ms in 3 patients. Significant concordance (kappa = 0.69, p <0.001) was found between the echocardiographic- and ECG-optimized VV interval. In conclusion, significant concordance appeared to exist during biventricular pacing between VV programming based on the shortest QRS interval at 12-lead ECG pacing and echocardiographic-guided VV-interval optimization. A combined ECG- and echocardiographic approach could be a less time-consuming solution in performing this operation.
|Data di pubblicazione:||2008|
|Titolo:||Interventricular delay interval optimization in cardiac resynchronization therapy guided by echocardiography versus guided by electrocardiographic QRS interval width.|
|Autore/i:||Bertini, M; Ziacchi, M; Biffi, M; Martignani, C; Saporito, D; Valzania, C; Diemberger, I; Cervi, E; Frisoni, J; Sangiorgi, D; Branzi, A; Boriani, Giuseppe|
|Digital Object Identifier (DOI):||10.1016/j.amjcard.2008.07.015|
|Codice identificativo ISI:||WOS:000261194000017|
|Codice identificativo Scopus:||2-s2.0-55249123455|
|Citazione:||Interventricular delay interval optimization in cardiac resynchronization therapy guided by echocardiography versus guided by electrocardiographic QRS interval width. / Bertini, M; Ziacchi, M; Biffi, M; Martignani, C; Saporito, D; Valzania, C; Diemberger, I; Cervi, E; Frisoni, J; Sangiorgi, D; Branzi, A; Boriani, Giuseppe. - In: THE AMERICAN JOURNAL OF CARDIOLOGY. - ISSN 0002-9149. - 102(10)(2008), pp. 1373-1377.|
|Tipologia||Articolo su rivista|
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