title: Atrioventricular interval optimization in the right atrial appendage and interatrial septum pacing: a comparison between echo and peak endocardial acceleration measurements.
abstract: Interatrial septum pacing (IASP) reduces interatrial conduction time and consequently may interfere with atrioventricular delay (AVD) optimization. We studied 14 patients with an implanted BEST Living system device able to measure peak endocardial acceleration (PEA) signal. The aims of our study were to compare the (1) optimal AVD (OAVD) in right atrial appendage pacing (RAAP) and IASP, and (2) OAVD derived by the PEA signal versus OAVD derived by Echo/Doppler evaluation of the left ventricular filling time (LVFT) and cardiac output (CO). Measurements were performed in DDD VDD modes Eight patients (group A) had RAAP and six patients (group B) had IASP. In group A, OAVD measured by LVFT, CO, and PEA was 185 +/- 23 ms, 177 +/- 19 ms, and 192 +/- 23 ms in DDD and 147 +/- 19 ms, 135 +/- 27 ms, and 146 +/- 20 ms in VDD, respectively. OAVD measured by LVFT, CO, and PEA was significantly longer in DDD mode than in VDD (P < 0.01, P < 0.01, P < 0.001). In group B, OAVD measured by LVFT, CO, and PEA was 116 +/- 19 ms, 113 +/- 10 ms, and 130 +/- 30 ms in DDD and 106 +/- 16 ms, 96 +/- 15 ms, and 108 +/- 26 ms in VDD, respectively. No statistical differences were observed between DDD and VDD. Significant correlations between OAVDs PEA derived and OAVDs LVFT and CO derived were observed (r = 0.71, r = 0.69, respectively). When new techniques of atrial stimulation, as IASP, are used an OAVD shorter and similar in VDD and DDD has to be considered. The BEST Living system could provide a valid method to ensure, in every moment, the exact required OAVD to maximize atrial contribution to CO.
authors.affiliation: Institute of Internal Medicine and Cardiology, University of Florence, Viale Morgagni 85, 50134 Florence, Italy. c.porciani@dfc.unifi.it
authors.forename: L
authors.initials: L
authors.lastname: Padeletti
authors.forename: M C
authors.initials: MC
authors.lastname: Porciani
authors.forename: P
authors.initials: P
authors.lastname: Ritter
authors.forename: A
authors.initials: A
authors.lastname: Michelucci
authors.forename: A
authors.initials: A
authors.lastname: Colella
authors.forename: P
authors.initials: P
authors.lastname: Pieragnoli
authors.forename: A
authors.initials: A
authors.lastname: Costoli
authors.forename: C
authors.initials: C
authors.lastname: Ciapetti
authors.forename: A
authors.initials: A
authors.lastname: Sabini
authors.forename: G
authors.initials: G
authors.lastname: Demarchi
authors.forename: L
authors.initials: L
authors.lastname: Gillio-Meina
authors.forename: G
authors.initials: G
authors.lastname: Gaggini
authors.forename: G F
authors.initials: GF
authors.lastname: Gensini
mesh_terms: D020517:Atrial Appendage; D002302:Cardiac Output; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D017147:Defibrillators, Implantable / Q000592:standards*; D004452:Echocardiography; D004699:Endocardium / Q000000981:diagnostic imaging; D005260:Female; D006327:Heart Block / Q000000981:diagnostic imaging / Q000601:surgery / Q000628:therapy*; D006334:Heart Function Tests; D006346:Heart Septum; D006801:Humans; D008297:Male; D008875:Middle Aged; D011930:Reaction Time; D016896:Treatment Outcome; D016277:Ventricular Function, Left