title: Interventricular delay interval optimization in cardiac resynchronization therapy guided by echocardiography versus guided by electrocardiographic QRS interval width.
abstract: Present devices for cardiac resynchronization therapy offer the possibility of tailoring the hemodynamic effect of biventricular pacing by optimization of the interventricular delay (VV) beyond atrioventricular (AV)-interval optimization. It was not yet defined whether a QRS width-based strategy may be a helpful tool for echocardiography for device programming. The aim of the study was to investigate the relation between VV-interval optimization guided by echocardiography and guided by QRS interval width. One hundred six patients with a cardiac resynchronization therapy device for > or =3 months were enrolled. All patients underwent echocardiographic AV and VV delay optimization. The AV interval was optimized according to the E wave-A wave (EA) interval and left ventricular filling time. At the optimal AV delay, VV optimization was performed by measuring the aortic velocity time integral at 5 different settings: simultaneous right and left ventricle output, left ventricle pre-excitation (left ventricle + 40 and 80 ms, respectively), and right ventricle pre-excitation (right ventricle + 40 and 80 ms, respectively). A 12-lead electrocardiogram was recorded and QRS duration was measured in the lead with the greatest QRS width. The electrocardiographic (ECG)-optimized VV interval was defined according to the narrowest achievable QRS interval among 5 VV intervals. The echocardiographic-optimized VV interval was left ventricle + 40 ms in 28 patients, left ventricle + 80 ms in 15 patients, simultaneous in 46 patients, right ventricle + 40 ms in 14 patients, and right ventricle + 80 ms in 3 patients. Significant concordance (kappa = 0.69, p <0.001) was found between the echocardiographic- and ECG-optimized VV interval. In conclusion, significant concordance appeared to exist during biventricular pacing between VV programming based on the shortest QRS interval at 12-lead ECG pacing and echocardiographic-guided VV-interval optimization. A combined ECG- and echocardiographic approach could be a less time-consuming solution in performing this operation.
authors.affiliation: Institute of Cardiology, University of Bologna, Bologna, Italy. doc.matber@gmail.com
authors.forename: Matteo
authors.initials: M
authors.lastname: Bertini
authors.forename: Matteo
authors.initials: M
authors.lastname: Ziacchi
authors.forename: Mauro
authors.initials: M
authors.lastname: Biffi
authors.forename: Cristian
authors.initials: C
authors.lastname: Martignani
authors.forename: Davide
authors.initials: D
authors.lastname: Saporito
authors.forename: Cinzia
authors.initials: C
authors.lastname: Valzania
authors.forename: Igor
authors.initials: I
authors.lastname: Diemberger
authors.forename: Elena
authors.initials: E
authors.lastname: Cervi
authors.forename: Jessica
authors.initials: J
authors.lastname: Frisoni
authors.forename: Diego
authors.initials: D
authors.lastname: Sangiorgi
authors.forename: Angelo
authors.initials: A
authors.lastname: Branzi
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Boriani
mesh_terms: D000368:Aged; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D004562:Electrocardiography; D005260:Female; D006333:Heart Failure / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000628:therapy*; D006801:Humans; D008297:Male; D014463:Ultrasonography