Acute Hemodynamic Benefits of Bi-Atrial Atrioventricular Sequential Pacing With the Optimal Atrioventricular Delay

Doi, Atsushi; Takagi, Masahiko; Toda, Iku; Yoshiyama, Minoru; Takeuchi, Kazuhide; Yoshikawa, Junichi

doi:10.1016/j.jacc.2005.04.032

Cited by 14 publications

(3 citation statements)

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“…According to Doi et al hemodynamic improvement obtained with bi-atrial pacing is related to the interatrial conduction delay. 20 Atrial conduction abnormalities were present in all our patients, although no differences between the groups were observed. Also, the paced P-wave duration did not differ between the groups, so both pacing modalities induced a similar degree of electrical resynchronization.…”

Section: Discussionmentioning

confidence: 57%

Atrial Function During Different Multisite Atrial Pacing Modalities in Patients With Bradycardia - Tachycardia Syndrome

Lewicka

Dąbrowska−Kugacka

Ruciński

et al. 2009

Circ J

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trial fibrillation (AF) is the most frequent arrhythmia observed in patients with an implanted pacemaker, and there are multiple factors for its etiology. [1][2][3] It has been shown that atrial pacing may have a preventive effect on AF recurrence. The antiarrhythmic effect of atrial pacing is not always immediate, but can be progressive in some patients, 4 and some pacing algorithms may also be useful. 5 Intra-and interatrial conduction disturbances are well-known factors predisposing to AF development and/or maintenance. Thus, the choice of atrial pacing site may play an important role in providing atrial electrical activation synchrony and diminishing the influence of abnormal atrial conduction on the incidence of AF. Some investigators have suggested that multisite atrial pacing (MAP), which incorporates 1 electrode in the right atrial appendage (RAA) and the other in the coronary sinus (CS) ostium area (dualsite atrial pacing) or in the mid-or distal CS (bi-atrial pacing), might be more beneficial than conventional RAA pacing. [6][7][8] Recently, our group proposed a novel method of MAP incorporating the Bachmann's bundle (BB) and CS ostium region. 9 This novel pacing modality presumes "double electrical resynchronization" of the left atrium (LA) and its antiarrhythmic effect has been shown in patients with AF. 9 However, up till now neither the optimal atrial pacing site nor the superiority of multisite over single-site atrial pacing has been ultimately determined.The aim of the study was to compare the hemodynamic effects of 2 MAP modalities and to determine the influence of the RA pacing lead positioning in the BB region compared with the typical RAA site on atrial contraction synchrony. It is presumed that beneficial hemodynamic effect of MAP would support its antiarrhythmic effect. Methods Patient PopulationWe studied 62 consecutive patients in whom MAP was conducted because of (1) sinus node dysfunction with class I or II indications for permanent cardiac pacing; (2) documented symptomatic AF recurrence (paroxysmal or persistent); (3) signs of advanced intra-and interatrial conduction delay: sinus P-wave duration ≥120 ms on the surface ECG; (4) no evidence of 2 nd or 3 rd degree atrioventricular (AV) block; and (5) Piotr Rucinski, MD*; Dariusz Kozlowski, MD, PhD; Grzegorz Raczak, MD, PhD; Andrzej Kutarski, MD, PhD* Background: Multisite atrial pacing (MAP) was introduced to improve atrial electrical synchrony and prevent recurrence of atrial fibrillation (AF). Methods and Results: In the present study there were 57 patients with sinus node disease, AF recurrence and prolonged P-wave on ECG with 2 MAP modalities. In all patients 1 lead was implanted in the coronary sinus (CS) ostium area. In the right atrial appendage (RAA)+CS group (28 patients) the other atrial lead was in the RAA, and in the BB+CS group (29 patients) in the Bachmann's bundle (BB) region. Tissue Doppler was used to register the electromechanical delay (EMD) in the atrial walls and estimate the atrial contraction synchrony. Cardiac o...

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Section: Discussionmentioning

confidence: 57%

Atrial Function During Different Multisite Atrial Pacing Modalities in Patients With Bradycardia - Tachycardia Syndrome

Lewicka

Dąbrowska−Kugacka

Ruciński

et al. 2009

Circ J

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“…The effect on OUES was measured after 4 weeks. Though this timing was arbitrary, the aim was to examine a sustained short-term effect of AV optimization on exercise capacity, in contrast to the established acute haemodynamic effects 4,5 . AV optimization in our study was performed at rest, using the validated iterative mitral inflow VTI method 6 .…”

Section: Discussionmentioning

confidence: 99%

“…Resolution of left AV asynchrony in DDD pacing can be obtained by AV delay optimization and has been shown to improve acute haemodynamics in patients with an important IACD 4,5 . Several validated methods for AV optimization exist 6 .…”

Section: The Cbravo Trial (Nct01998256)mentioning

confidence: 99%

Clinical benefit of atrio-ventricular delay optimization in patients with a dual-chamber pacemaker: a pilot study. The CBRAVO trial (NCT01998256)

et al. 2016

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Objective Outcome data on exercise capacity following atrio-ventricular (AV) optimization of dual-chamber pacing are sparse. Pacemaker settings are often left at manufacturers' nominal values upon implantation. We studied the short-term effect of AV optimization on exercise capacity in patients with a dual-chamber pacemaker. Methods and resultsTwenty-eight patients (mean age 73 ± 14 y) with a dual-chamber pacemaker, were randomized towards either nominal AV settings (group 1) or echo-guided AV optimization using the iterative mitral inflow VTI (velocity time integral) method (group 2) at baseline. At 4 weeks, patients were crossed-over to AV optimization in group 1 and returned to nominal AV settings in group 2 for another period of 4 weeks.Oxygen uptake efficiency slope improved significantly after AV optimization (by 126.7 mL/logL ± 190.7 mL/logL; P = 0.003).Conclusions AV optimization in dual-chamber pacing significantly improved functional capacity after 4 weeks. These data provide the background for further validation studies. Keywords AV optimization -interatrial conduction delay -interatrial mechanical delay -dual-chamber pacemaker.contraction of the left atrium can compromise left ventricular filling, leading to an early increase in atrial filling pressures and a limitation in functional exercise capacity 2 . Oxygen uptake efficiency slope (OUES) is a validated marker of exercise capacity in healthy subjects and in patients with heart failure 3 .Resolution of left AV asynchrony in DDD pacing can be obtained by AV delay optimization and has been shown to improve acute haemodynamics in patients with an important IACD 4,5 . Several validated methods for AV optimization exist 6 . However, data on the effects of this intervention on short-and long-term clinical end points as exercise capacity, morbidity and mortality, are sparse.The aim of this pilot study was to investigate the short-term effect of AV optimization on functional [ Original article ]

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The Standard Electrocardiogram During Cardiac Resynchronization

Barold¹,

Giudici²,

Herweg³

Devices for Cardiac Resynchronization

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Acute Hemodynamic Benefits of Bi-Atrial Atrioventricular Sequential Pacing With the Optimal Atrioventricular Delay

Abstract: Bi-atrial pacing made the most significant improvements of hemodynamics. These benefits may be due to the improvements in interatrial conduction delay and atrial dyssynchrony.

Cited by 14 publications

References 14 publications

Atrial Function During Different Multisite Atrial Pacing Modalities in Patients With Bradycardia - Tachycardia Syndrome

Atrial Function During Different Multisite Atrial Pacing Modalities in Patients With Bradycardia - Tachycardia Syndrome

Clinical benefit of atrio-ventricular delay optimization in patients with a dual-chamber pacemaker: a pilot study. The CBRAVO trial (NCT01998256)

The Standard Electrocardiogram During Cardiac Resynchronization

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