Aim Cardiac resynchronization is a well tolerated and effective therapy for heart failure, but 30% of patients still do not respond to biventricular pacing. Optimization of device settings, in particular interventricular delay value, represents a plausible target for improving these results, but available literature is discordant. We aimed our study at the identification of the best suitable candidates to interventricular delay optimization. Methods A total of 77 consecutive patients with optimized drugs therapy underwent clinical, echocardiographic and electrocardiographic evaluation before and after 6 months from implantation of a biventricular defibrillator in accordance to current guidelines. In each patient, atrioventricular and interventricular delay values were optimized at predischarge with echocardiogram. Results The only predictor of an optimized interventricular delay value different from simultaneous (i.e. standard shipment setting), at both univariate and multivariate analyses, was a QRS duration greater than 160ms (odds ratio 22.958; PU0.003) with a sensitivity of 70.9%. Conclusion Candidates to cardiac resynchronization therapy with a basal QRS greater than 160ms have a higher chance of requiring echo-guided tailoring of interventricular delay value. A strategy based on these data can potentially improve device programming, reducing by one-third the need for optimization, according to our findings, and at the same time avoid unnecessary timeconsuming procedures.

Predictors of nonsimultaneous interventricular delay at cardiac resynchronization therapy optimization / Ziacchi, Matteo; Diemberger, Igor; Biffi, Mauro; Martignani, Cristian; Bertini, Matteo; Rocchi, Guido; Biagini, Elena; Graziosi, Maddalena; Mazzotti, Andrea; Rapezzi, Claudio; Boriani, Giuseppe. - In: JOURNAL OF CARDIOVASCULAR MEDICINE. - ISSN 1558-2027. - 17:4(2016), pp. 299-305. [10.2459/JCM.0000000000000196]

Predictors of nonsimultaneous interventricular delay at cardiac resynchronization therapy optimization

BORIANI, Giuseppe
2016

Abstract

Aim Cardiac resynchronization is a well tolerated and effective therapy for heart failure, but 30% of patients still do not respond to biventricular pacing. Optimization of device settings, in particular interventricular delay value, represents a plausible target for improving these results, but available literature is discordant. We aimed our study at the identification of the best suitable candidates to interventricular delay optimization. Methods A total of 77 consecutive patients with optimized drugs therapy underwent clinical, echocardiographic and electrocardiographic evaluation before and after 6 months from implantation of a biventricular defibrillator in accordance to current guidelines. In each patient, atrioventricular and interventricular delay values were optimized at predischarge with echocardiogram. Results The only predictor of an optimized interventricular delay value different from simultaneous (i.e. standard shipment setting), at both univariate and multivariate analyses, was a QRS duration greater than 160ms (odds ratio 22.958; PU0.003) with a sensitivity of 70.9%. Conclusion Candidates to cardiac resynchronization therapy with a basal QRS greater than 160ms have a higher chance of requiring echo-guided tailoring of interventricular delay value. A strategy based on these data can potentially improve device programming, reducing by one-third the need for optimization, according to our findings, and at the same time avoid unnecessary timeconsuming procedures.
2016
17
4
299
305
Predictors of nonsimultaneous interventricular delay at cardiac resynchronization therapy optimization / Ziacchi, Matteo; Diemberger, Igor; Biffi, Mauro; Martignani, Cristian; Bertini, Matteo; Rocchi, Guido; Biagini, Elena; Graziosi, Maddalena; Mazzotti, Andrea; Rapezzi, Claudio; Boriani, Giuseppe. - In: JOURNAL OF CARDIOVASCULAR MEDICINE. - ISSN 1558-2027. - 17:4(2016), pp. 299-305. [10.2459/JCM.0000000000000196]
Ziacchi, Matteo; Diemberger, Igor; Biffi, Mauro; Martignani, Cristian; Bertini, Matteo; Rocchi, Guido; Biagini, Elena; Graziosi, Maddalena; Mazzotti, Andrea; Rapezzi, Claudio; Boriani, Giuseppe
File in questo prodotto:
File Dimensione Formato  
ziacchi2016.pdf

Accesso riservato

Tipologia: Versione pubblicata dall'editore
Dimensione 313.62 kB
Formato Adobe PDF
313.62 kB Adobe PDF   Visualizza/Apri   Richiedi una copia
Pubblicazioni consigliate

Licenza Creative Commons
I metadati presenti in IRIS UNIMORE sono rilasciati con licenza Creative Commons CC0 1.0 Universal, mentre i file delle pubblicazioni sono rilasciati con licenza Attribuzione 4.0 Internazionale (CC BY 4.0), salvo diversa indicazione.
In caso di violazione di copyright, contattare Supporto Iris

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11380/1139651
Citazioni
  • ???jsp.display-item.citation.pmc??? 0
  • Scopus 4
  • ???jsp.display-item.citation.isi??? 4
social impact