Long‐Term Variations in Optimal Programming of Cardiac Resynchronization Therapy Devices

Abstract

The optimal follow-up and long-term programming of cardiac resynchronization therapy (CRT) devices are uncertain. The aim of this study was to quantify the temporal variations in programming parameters to optimize the follow-up of these devices. Before, during, and at specified intervals over 9 months after implant, 40 recipients of CRT devices were studied. At each visit, the patients were tested with a fixed sequence of stimulation parameters during echocardiographic and electrocardiographic (ECG) recordings. The optimal AV delay and inter-ventricular delays (V-V) were determined according to echocardiographic criteria. The echocardiographic data were, in turn, compared with the ECG recordings. Among the 40 patients, the optimal stimulation parameters remained unchanged throughout the follow-up in only three patients. In 18 patients, adjustments were required at each follow-up sessions. There was a trend toward reduction in the left ventricular (LV) predominance of the optimal V-V delay and an increase in the AV delay during follow-up. The mean optimal V-V delay at implant was 22 ms (-12 to +32 ms) with the LV activated first, versus 12 ms (-16 to +32 ms) at 9 months. The mean AV delay at implant was 115 ms versus 137 ms at 9 months. Individual changes could not be accurately predicted. The optimal stimulation parameters for CRT vary over time. Detailed, regular reevaluations, and reprogramming of optimal parameters may be appropriate.

Comprehensive cardiac resynchronization therapy optimization in the real world

“…Whether and how AV intervals should regularly be evaluated and adjusted remains a matter of debate [7][8][9]. In various preliminary studies, optimization of the AV delay has been demonstrated to significantly increase hemodynamic response, New York Heart Association (NYHA) class, LVEF and B-type natriuretic peptide level in the short-time follow-up [10][11][12][13][14].…”

Optimal Cardiac Pacing with Q Learning

“…The guarantee to converge to the optimal AV delay and VV interval is the valuable benefit of using a sophisticated machine learning method, such as QL, in a CRT pacemaker. Since the AV delay and VV interval parameters are crucial for the success of the therapy [10][11][12][13]21], the guarantee to converge to the optimal AV delay and VV interval is an important advantage over other optimization methods that do not guarantee convergence to optimal values. Furthermore, this advantage should open the door to implementation of machine learning methods, such as QL, in implanted medical devices such as CRT pacemakers and defibrillators.…”

“…In addition the authors showed that changes from rest to exercise in LV dyssynchrony were correlated with changes in stroke volume and changes in mitral regurgitation. Odonnell et al [12] showed, in 43 CHF patients after CRT implantation in a follow-up study, that the optimal AV delay and VV interval found with echocardiography changed significantly over 9 months of follow-up period. G. Rocchi et al [13] showed recently that exercise stress Echo is superior to rest echo in predicting LV reverse remodelling and functional improvement after CRT.…”

Interventional Electrophysiology and Cardiac Resynchronization Therapy

“…If any ventricular remodeling has occurred, then the previously optimized values are likely to have changed. 58 The methodology of optimization is discussed later.…”