Effects of CRT Interval Optimization on Continuous Left Atrial Pressure Waveforms in Ambulant Heart Failure Patients and Inter-Patient Repeatability

Chan, W.; Troughton, Richard W.; Blomqvist, Andreas; Melton, Iain; Crozier, Ian; Noren, K.

doi:10.1016/j.cardfail.2011.06.189

Cited by 1 publication

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“…Stahlberg et al ., by means of an indirect estimate of the LA end‐diastolic pressure—derived from the estimated pulmonary artery diastolic pressure obtained from a sensor in the RV outflow tract (Implantable Haemodynamic Monitor (IHM) Chronicle ® , Medtronic Inc., USA)—were able to show lower LA‐derived pressures following AV optimization (21.9 ± 8.1 mmHg vs. 23 ± 7.7 mmHg, respectively, P < 0.05) . Recently, using a novel direct continuous invasive ambulatory LA monitoring system (HeartPOD™ ISL St Jude Medical) the optimal AV delay (also using the transmitral iterative method) clearly correlated with a reduction in the LA pressures and improved LA filling profile …”

Section: Discussionmentioning

confidence: 99%

“…23 Recently, using a novel direct continuous invasive ambulatory LA monitoring system (HeartPOD TM ISL St Jude Medical) the optimal AV delay (also using the transmitral iterative method) clearly correlated with a reduction in the LA pressures and improved LA filling profile. 24 Who should undergo atrioventricular optimization?…”

Section: Physiological Impact Of Atrioventricular Optimizationmentioning

confidence: 99%

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Effect of atrioventricular optimization on circulating N‐terminal pro brain natriuretic peptide following cardiac resynchronization therapy

Shanmugam

Campos

Prada-Delgado

et al. 2013

European J of Heart Fail

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AimsFollowing CRT, atrioventricular (AV) optimization is not routinely practised. To evaluate its clinical utility, we examined the effect of AV delay optimization on the prognostic biomarker NT-proBNP. Methods and resultsWe prospectively studied 72 patients (mean age 73 + 12.5 years, 70.8% male, 55.6% ischaemic) undergoing iterative AV optimization. Patients were divided into those whose nominal setting appeared ideal and not changed (Group 1, n ¼ 22) and those whose AV delay was optimized (Group 2, n ¼ 50). All patients underwent NT-proBNP assessment prior to CRT, and pre-and a median 5 days post-optimization. Compared with Group 1, NT-proBNP fell significantly in Group 2 patients (median 474 pg/mL) following optimization (P ¼ 0.00001). A significant change in filling pattern (defined as a change in AV delay .50 ms) was required in 30% of patients, and it was this subgroup that derived the greater reduction in NT-proBNP levels [-1407 pg/mL, interquartile range (IQR) -3042 to -346 pg/mL] compared with those requiring ,50 ms AV delay change ( -125 pg/mL, IQR -1038 to 6 pg/mL), P ¼ 0.0011. The benefit of AV optimization was principally observed in reverse remodelling non-responders (median -2167 pg/mL, IQR -3042 to -305 pg/mL) and in patients with a pseudonormal or restrictive filling pattern (median -1407 pg/mL, IQR -2809 to -342 pg/mL), compared with those with more benign diastolic filling (median -264 pg/mL, IQR -1038 to -21 pg/ mL), P ¼ 0.033. ConclusionsIn one-third of patients, major filling pattern changes are achieved with AV optimization, associated with subsequent rapid falls in NT-proBNP. The greater the AV delay change, the larger the NT-proBNP fall, and non-responders and those with restrictive or pseudonormal filling despite CRT are most likely to benefit.--

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Section: Discussionmentioning

confidence: 99%

Section: Physiological Impact Of Atrioventricular Optimizationmentioning

confidence: 99%