An electrographic AV optimization for the maximum integrative atrioventricular and ventricular resynchronization in CRT

摘要

Background Atrioventricular (AV) delay could affect AV and ventricular synchrony in cardiac resynchronization therapy (CRT). Strategies to optimize AV delay according to optimal AV synchrony (AV(opt-AV)) or ventricular synchrony (AV(opt-V)) would potentially be discordant. This study aimed to explore a new AV delay optimization algorithm guided by electrograms to obtain the maximum integrative effects of AV and ventricular resynchronization (opt-AV). Methods Forty-nine patients with CRT were enrolled. AV(opt-AV) was measured through the Ritter method. AV(opt-V) was obtained by yielding the narrowest QRS. The opt-AV was considered to be AV(opt-AV) or AV(opt-V) when their difference was < 20 ms, and to be the AV delay with the maximal aortic velocity-time integral between AV(opt-AV) and AV(opt-V) when their difference was > 20 ms. Results The results showed that sensing/pacing AV(opt-AV) (SAV(opt-AV)/PAV(opt-AV)) were correlated with atrial activation time (Pend-As/Pend-Ap) (P < 0.05). Sensing/pacing AV(opt-V) (SAV(opt-V)/PAV(opt-V)) was correlated with the intrinsic AV conduction time (As-Vs/Ap-Vs) (P < 0.01). The percentages of patients with more than 20 ms differences between SAV(opt-AV)/PAV(opt-AV) and SAV(opt-V)/PAV(opt-V) were 62.9% and 57.1%, respectively. Among them, opt-AV was linearly correlated with SAV(opt-AV)/PAV(opt-AV) and SAV(opt-V)/PAV(opt-V.) The sensing opt-AV (opt-SAV) = 0.1 x SAV(opt-AV) + 0.4 x SAV(opt-V) + 70 ms (R-2 = 0.665, P < 0.01) and the pacing opt-AV (opt-PAV) = 0.25 x PAV(opt-AV) + 0.5 x PAV(opt-V) + 30 ms (R-2 = 0.560, P < 0.01). Conclusion The SAV(opt-AV)/PAV(opt-AV) and SAV(opt-V)/PAV(opt-V) were correlated with the atrial activation time and the intrinsic AV conduction interval respectively. Almost half of the patients had a > 20 ms difference between SAV(opt-AV)/PAV(opt-AV) and SAV(opt-V)/PAV(opt-V). The opt-AV could be estimated based on electrogram parameters.

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