Programming Optimal Atrioventricular Delay in Dual Chamber Pacing Using Peak Endocardial Acceleration: Comparison with a Standard Echocardiographic Procedure

Abstract

Optimization of programmed atrioventricular delay in dual chamber pacing is essential to the hemodynamic efficiency of the heart. Automatic AV delay optimization in an implanted pacemaker is highly desirable. Variations of peak endocardial acceleration (PEA) with AV delay at rest correlate well with echocardiography derived observations, particularly with end-diastolic filling and mitral valve closure timings. This suggests the possibility of devicing a procedure for the automatic determination of the optimal AV delay. The aim of this study was to compare a proposed algorithm for optimal AV delay determination with an accepted echocardiographic method. Fifteen patients with high degree AV block received BEST-Living pacing systems. Automatic AV delay scans were performed at rest (60-300 ms in 20-ms steps with 60 beats per step) in DDD at 90 ppm, while simultaneously recording cycle-by-cycle PEA values, which were averaged for each AV delay to obtain a PEA versus AV delay curve. Nonlinear regression analysis based on a Boltzmann sigmoid curve was performed, and the optimal AV delay (OAVD) was chosen as the sigmoid inflection point of the regression curve. The OAVD was also evaluated for each patient using the Ritter echocardiographic method. Good sigmoid fit was obtained in 13 of 15 patients. The mean OAVD obtained by the PEA sigmoid algorithm was 146.9 +/- 32.1 ms, and the corresponding result obtained by echocardiography was 156.4 +/- 34.3 ms (range 31.8-39.7 ms). Correlation analysis yielded r = 0.79, P = 0.0012. In conclusion, OAVD estimates obtained by PEA analysis during automatic AV delay scanning are consistent with those obtained by echocardiography. The proposed algorithm can be used for automatic OAVD determination in an implanted pacemaker pulse generator.

Analysis of cardiac micro-acceleration signals for the estimation of systolic and diastolic time intervals in cardiac resynchronization therapy

“…Cardiac Resynchronization Therapy (CRT) is indicated for patients suffering from drug-refractory congestive heart failure (CHF) associated with inter-ventricular dyssynchrony [1]. The implantation of a bi-ventricular stimulator makes it possible to re-synchronize the electrical activation of both ventricles.…”

“…In particular, the peak to peak amplitude of first component of the EA signal (EA1) is well correlated to the maximum rate of rise of left ventricular pressure [8] and has been successfully used to optimize CRT [1].…”

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

“…In patients with complete AV block and an implanted DDD pacemaker, Ritter et al reported a highly significant difference between the optimal AV delay obtained by echocardiography and that obtained by the peak endocardial accel- eration (PEA) method, which corresponds to the 'knee' of the PEA curve vs the AV delay. 20,21 PEA is detected by a ventricular lead equipped with a micro-accelerometer. Various reports have shown that PEA is synchronous with S1.…”

New Cardiomechanic Pacing Lead Sensor Based on High Frequency Parameters: Experimental Studies in Sheep

“…Nevertheless, our first step of evaluation should be to optimize the AV delay [32][33][34] in the pacemaker and CRT population.…”