Improvement of Cardiac Function in Patients with Severe Congestive Heart Failure and Coronary Artery Disease by Dual Chamber Pacing with Shortened AV Delay

Auricchio, Angelo; Sommariva, Luigi; Salo, Rodney W.; Scafuri, Antonio; Chiariello, Luigi

doi:10.1111/j.1540-8159.1993.tb00997.x

Cited by 129 publications

(45 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…11 It has been reported that biventricular pacing can improve the hemodynamics in patients with congestive heart failure, 13 but the importance of optimizing AV delay is still controversial. [1][2][3]14 The optimal AV delay may change from time to time with changes in cardiac function, although in previous reports 1,2,14 it has been fixed. However, in each patient the optimal AV delay may not be a fixed value and thus should be adjusted constantly.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Optimization of Atrioventricular Delay and Follow-up in a Patient With Congestive Heart Failure With an Implanted DDD Pacemaker

et al. 2001

View full text Add to dashboard Cite

he efficacy of a short atrioventricular (AV) delay in patients with severely impaired cardiac function has been reported, 1-3 but the delay required to achieve optimal AV synchrony varies from patient to patient and may change with changes in cardiac function.Diastolic mitral regurgitation (MR) is observed in patients with elevated left ventricular end-diastolic pressure 4 and can be induced by prolonging the AV delay in patients with DDD pacemakers. [5][6][7][8][9][10][11][12] Cardiac function may be improved by AV sequential pacing and by setting the AV delay at less than the critical PQ interval for the appearance of diastolic MR when the latter is observed in patients with intrinsic AV conduction. 11 We have determined a new formula for predicting the optimal AV delay using Doppler echocardiography: optimal AV delay = slightly prolonged AV delay -interval between the end of the atrial kick and complete closure of the mitral valve (duration of diastolic MR) at the AV delay setting (Fig 1). 12 We report a patient with severe congestive heart failure who remained in good condition for more than 4 years with pacemaker implantation and AV delay optimization. Case ReportThe patient, an 84-year-old man with an old myocardial infarction, had had percutaneous transluminal angioplasty for total occlusion of the proximal portion of the left ascending artery successfully performed in August 1994. Although there had not been restenosis or progression of the coronary artery lesion, he had repeated admissions to hospital for congestive heart failure (Fig 2A). Medications were unchanged during follow-up (oral administration of furosemide 40 mg, spironoractone 25 mg, digoxine 0.125 mg, captopril 18.75 mg, isosorbide dinitrate 60 mg, nicorandil 15 mg, aspirin 100 mg daily). He complained of dizziness, but the dose of captopril could not be increased andblocker could not be used because of the risk of hypotension or bradycardia.ECG showed prolongation of the PQ interval (0.28 s) and complete left bundle branch block (Fig 2B). The Hisventricular interval was prolonged (90 ms on intracardiac electrocardiogram) and the ejection fraction was 31%, estimated by left ventriculography. Marked diastolic MR was detected ( Fig 3A) and during 80 beats/min AV sequential pacing, it was observed when the AV delay was set at 240 ms. The interval between the end of the atrial kick and complete closure of the mitral valve (duration of diastolic MR) was 120 ms (Fig 3B). Therefore, by our method, the predicted optimal AV delay was 240 -120 = 120 ms, and the diastolic MR disappeared when the AV delay was set at 120 ms (Fig 3C). Cardiac output was 4.7 L/min during 80 /min Tomohiko Shigemasa, MD; Tsutomu Endo, MD; Kazuo Kimura, MD; Takashi Usui, MD; Satoshi Umemura, MD It has been reported that cardiac function can be improved by implanting a DDD pacemaker (PM) and setting a short atrioventricular (AV) delay in patients with impaired cardiac function. A previous report found that the critical AV delay that induces diastolic mitral regurgitation (MR)...

show abstract

Section: Discussionmentioning

confidence: 99%

“…he efficacy of a short atrioventricular (AV) delay in patients with severely impaired cardiac function has been reported, [1][2][3] but the delay required to achieve optimal AV synchrony varies from patient to patient and may change with changes in cardiac function.…”

mentioning

confidence: 99%

Optimization of Atrioventricular Delay and Follow-up in a Patient With Congestive Heart Failure With an Implanted DDD Pacemaker

et al. 2001

View full text Add to dashboard Cite

show abstract

“…Although the efficacy of a short AV delay in patients with severely impaired cardiac function has been reported, [1][2][3][4][5] conventional DDD pacing with AV delay optimization is not always effective for congestive heart failure. In fact, right ventricular pacing during AV sequential pacing has deleterious effects.…”

Section: Discussionmentioning

confidence: 99%

“…but the importance of optimizing the AV delay is still controversial [1][2][3][4]20 in DDD pacing for congestive heart failure. The optimal AV delay may change with changes in cardiac function, but has been fixed in previous reports.…”

Section: Discussionmentioning

confidence: 99%

Long-Term Follow-up of Atrioventricular Delay Optimization in Patients With Biventricular Pacing

Inoue

Ishikawa

Sumita

et al. 2005

Circ J

View full text Add to dashboard Cite

he efficacy of a short atrioventricular (AV) delay in patients with severely impaired cardiac function has been reported, 1-5 but right ventricular pacing during AV sequential pacing has deleterious effects. 6 It has been reported that biventricular pacing can improve the hemodynamics in patients with congestive heart failure, [7][8][9][10] and as both AV delay optimization and shortening of the ventricular activation sequence are important in patients with severely impaired cardiac function, 11 AV delay optimization may also be important during biventricular pacing. 5 However, the optimal AV delay may not be a fixed value in each patient and may need to be frequently calculated.Diastolic mitral regurgitation (MR) is observed in patients with elevated left ventricular end-diastolic pressure 12 and can be induced by prolonging the AV delay in patients with DDD pacemakers. [5][6][12][13][14][15][16][17][18][19] Cardiac function may be improved by AV sequential pacing and setting the AV delay under the critical PQ interval for the appearance of diastolic MR when diastolic MR is observed in patients with intrinsic AV conduction. [4][5][6] We have determined a formula 16 for predicting the optimal AV delay using Doppler echocardiography: optimal AV delay = slightly prolonged AV delay -the interval between the end of the atrial kick and complete closure of the mitral valve (duration of diastolic MR) at the AV delay setting (Fig 1).In this study, we evaluated the efficacy of our method of Circulation Journal Vol.69, February 2005AV delay optimization using Doppler echocardiography in patients with biventricular pacing. MethodsThe study included 5 consecutive patients ranging in age from 60 to 77 years (67.4±8.0; mean ± SD) with severe congestive heart failure and an implanted biventricular pacemaker selected between December 1999 and September 2001. New York Heart Association (NYHA) class was III-IV before biventricular pacemaker implantation. Two (40%) of the 5 patients were taking angiotensin-converting enzyme inhibitors, 2 (40%) were receiving angiotensin-receptor blockers, 3 (33%) were receiving digitalis, 1 (20%) was receiving nitrates, and 5 (100%) were receiving diuretics. Beta-blockers were not prescribed in any patient because of the severe hypotension and bronchial asthma. Patients with chronic atrial fibrillation were excluded. Four patients had idiopathic dilated cardiomyopathy and one had ischemic cardiomyopathy. The LV ejection fraction was 23.6±7.1%.Optimal AV delay was predicted by our method. 16 Cardiac output (CO) and diastolic filling time were measured by Doppler echocardiography when the AV delay was set at the predicted optimal AV delay, the predicted optimal AV delay -25 ms and the predicted optimal AV delay + 25 ms.The follow-up period was 2.3±1.1 (0.8-3.8) years after biventricular pacemaker implantation. We evaluated the severity of congestive heart failure by NYHA class and the optimal AV delay was estimated every 3-6 months (Fig 2). When the end of the A wave on transmitral flow coincided wi...

show abstract

“…[1][2][3][4][5][6] The optimal AV delay allows completion of end-diastolic filling flow prior to ventricular contraction, providing the longest diastolic filling time, consequently increasing cardiac output and reducing the pulmonary wedge pressure. To determine the optimal AV delay, pulsed Doppler echocardiography is commonly used, 4 and our method was reported previously.…”

mentioning

confidence: 99%

Novel Method of Predicting the Optimal Atrioventricular Delay in Patients With Complete AV Block, Normal Left Ventricular Function and an Implanted DDD Pacemaker

Miki

Ishikawa

Matsushita

et al. 2009

Circ J

View full text Add to dashboard Cite

Circ J 2009; 73: 654 -657 t is important to set the optimal atrioventricular (AV) delay to achieve optimal AV synchrony in patients with an implanted DDD pacemaker. [1][2][3][4][5][6] The optimal AV delay allows completion of end-diastolic filling flow prior to ventricular contraction, providing the longest diastolic filling time, consequently increasing cardiac output and reducing the pulmonary wedge pressure. To determine the optimal AV delay, pulsed Doppler echocardiography is commonly used, 4 and our method was reported previously. 5,[7][8][9][10][11][12][13] However, echocardiography has several problems. The examination is time-consuming, and the optimal AV delay varies from patient to patient and with the patient's heart rate during exercise, sleep and other activities. Therefore, although the optimal AV delay is set using echocardiography only once, that value may not be adequate in the patient's daily life. If a more simple method of assessing the optimal AV delay was available, the delay could be set more frequently. Therefore, the aim of this study was to predict the optimal AV delay by a novel method using phonocardiography. Methods Study PopulationWe included 6 patients (mean age 72.7±5.7 [SD] years, 3 males) with complete AV block, normal left ventricular (LV) function and an implanted DDD pacemaker (Table). Informed consent was given by each participant before enrollment in this study. Study ProtocolThe amplitude of the first heart sound (S1) was recorded on a phonocardiogram (PCG) during AV sequential pacing. Transmitral flow and the time velocity integral (TVI) of the LV outflow tract (LVOT) were measured by pulsed Doppler echocardiography at the same time. The AV delay was set from 50 to 250 ms in a stepwise fashion at 20-or 25-ms increments. The pacing rate was fixed at 70-80 beats/min to maintain atrial and ventricular pacing. All patients were examined at rest in the left lateral decubitus position, at the end of each 5-min period of AV sequential pacing. Measurement of S1An acceleration-type PCG microphone (MA-250, Fukuda Denshi, Tokyo, Japan) was positioned at the cardiac apex and connected to an echocardiograph. Phonocardiograms were filtered from 20 to 600 Hz and recorded on the echocardiograph. The S1 amplitude from peak to peak was measured. The acceleration-type PCG microphone converts the vibration of chest by the heartbeat to electrical signals according to acceleration. There was little PCG noises and (Received April 16, 2008; revised manuscript received November 14, 2008; accepted December 7, 2008; released online February 26, 2009 Background: The optimal atrioventricular (AV) delay setting is important for achieving optimal AV synchrony in patients with an implanted DDD pacemaker. Using pulsed Doppler echocardiography is the most common method of predicting the optimal AV delay, but it is a complicated and time-consuming method. Therefore, an automatic optimizing function of the AV delay at different atrial rates is desirable for achieving a favorable hemodynamic state. This...

show abstract

Improvement of Cardiac Function in Patients with Severe Congestive Heart Failure and Coronary Artery Disease by Dual Chamber Pacing with Shortened AV Delay

Cited by 129 publications

References 11 publications

Optimization of Atrioventricular Delay and Follow-up in a Patient With Congestive Heart Failure With an Implanted DDD Pacemaker

Optimization of Atrioventricular Delay and Follow-up in a Patient With Congestive Heart Failure With an Implanted DDD Pacemaker

Long-Term Follow-up of Atrioventricular Delay Optimization in Patients With Biventricular Pacing

Novel Method of Predicting the Optimal Atrioventricular Delay in Patients With Complete AV Block, Normal Left Ventricular Function and an Implanted DDD Pacemaker

Contact Info

Product

Resources

About