Validation of a peak endocardial acceleration-based algorithm to optimize cardiac resynchronization: early clinical results

Abstract

AimsCardiac resynchronization therapy (CRT) involves time-consuming procedures to achieve an optimal programming of the system, at implant as well as during follow-up, when remodelling occurs. A device equipped with an implantable sensor able to measure peak endocardial acceleration (PEA) has been recently developed to monitor cardiac function and to guide CRT programming. During scanning of the atrioventricular delay (AVD), PEA reflects both left ventricle (LV) contractility (LV dP/dtmax) and transmitral flow. A new CRT optimization algorithm, based on recording of PEA (PEAarea method) was developed, and compared with measurements of LV dP/dtmax, to identify an optimal CRT configuration.Methods and resultsWe studied 15 patients in New York Heart Association classes II–IV and with a QRS duration >130 ms, who had undergone implantation of a biventricular (BiV) pulse generator connected to a right ventricular (RV) PEA sensor. At a mean of 39 ± 15 days after implantation of the CRT system, the patients underwent cardiac catheterization. During single-chamber LV or during BiV stimulation, with initial RV or LV stimulation, and at settings of interventricular intervals between 0 and 40 ms, the AVD was scanned between 60 and 220 ms, while LV dP/dtmax and PEA were measured. The area of PEA curve (PEAarea method) was estimated as the average of PEA values measured during AVD scanning. A ≥10% increase in LV dP/dtmax was observed in 12 of 15 patients (80%), who were classified as responders to CRT. In nine of 12 responders (75%), the optimal pacing configuration identified by the PEAarea method was associated with the greatest LV dP/dtmax.ConclusionThe concordance of the PEAarea method with measurements of LV dP/dtmax suggests that this new, operator-independent algorithm is a reliable means of CRT optimization.

Optimal Algorithm Switching for the Estimation of Systole Period From Cardiac Microacceleration Signals (SonR)

“…Recently, Sorin CRM SAS (Clamart, France) developed a piezo-electric micro-accelerometer inserted into the tip of an endocardial pacing lead (SonR sensor). This sensor provides an endocardial micro-acceleration signal, that may be useful for the continuous optimization of the delivered CRT [8]- [11]. This sensor could also provide complementary information that would be useful to improve remote patient follow-up and the early-detection of undesired events [12].…”

Future of Implantable Devices for Cardiac Rhythm Management

“…64 Pulmonary arterial (PA) pressure and PA wedge pressure monitoring can provide tailored therapy for patients admitted with advanced HF. 65 Ambulatory monitoring of RV pressure to derive PA diastolic pressure has been achieved with the use of a piezoelectric crystal incorporated into the tip of a pacing lead positioned at the RV outflow region.…”

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.…”