Comparison between IEGM-based approach and echocardiography in AV/PV and VV delay optimization in CRT-D recipients (Quicksept study).
BACKGROUND
AtrioVentricular (AV) and InterVentricular (VV) delay optimization can improve ventricular function in Cardiac Resynchronization Therapy (CRT) and is usually performed by means of echocardiography. St Jude Medical has developed an automated algorhythm which calculates the optimal AV and VV delays (QuickOpt™) based on Intracardiac ElectroGrams, (IEGM), within 2 min. So far, the efficacy of the algorhythm has been tested acutely with standard lead position at right ventricular (RV) apex. Aim of this project is to evaluate the algorhythm performance in the mid- and long-term with RV lead located in mid-septum.


METHODS
AV and VV delays optimization data were collected in 13 centers using both echocardiographic and QuickOpt™ guidance in CRTD implanted patients provided with this algorhythm. Measurements of the aortic Velocity Time Integral (aVTI) were performed with both methods in a random order at pre-discharge, 6-month and 12-month follow-up.


RESULTS
Fifty-three patients were studied (46 males; age 68 ± 10y; EF 28 ± 7%). Maximum aVTI obtained by echocardiography at different AV delays, were compared with aVTI acquired at AV delays suggested by QuickOpt. The AV Pearson correlations were 0.96 at pre-discharge, 0.95 and 0,98 at 6- and 12- month follow-up respectively. After programming optimal AV, the same approach was used to compare echocardiographic aVTI with aVTI corresponding to the VV values provided by QuickOpt. The VV Pearson Correlation were 0,92 at pre-discharge, 0,88 and 0.90 at 6-month and 12- month follow-up respectively.


CONCLUSIONS
IEGM-based optimization provides comparable results with echocardiographic method (maximum aVTI) used as reference with mid-septum RV lead location.
Cardiology Department, Ospedale Maria Vittoria, Via Cibrario 72, Torino, Italy. Electronic address: stent.icd@gmail.com.
Massimo
M
Giammaria
Cardiology Department, Ospedale SS Annunziata, Via Felice Migliori, 1, Cosenza, Italy.
Gianluca
G
Quirino
Cardiology Department, Ospedale Maria Vittoria, Via Cibrario 72, Torino, Italy.
Enrico
E
Cecchi
Cardiology Department, Ospedale Civile, Piazza Credenza, 2, Ivrea, TO, Italy; Cardiology Department, Ospedale di Cirie', Via Battitore, 79, Cirie', TO, Italy.
Gaetano
G
Senatore
Cardiology Department, Ospedale Civile, Piazza Credenza, 2, Ivrea, TO, Italy.
Paolo
P
Pistelli
Cardiology Department, Ospedale Santa Corona, Via XXV Aprile, 38, Pietra Ligure, SV, Italy.
Mario
M
Bocchiardo
Cardiology Department, Ospedale di Imperia, Via Sant'Agata,57, Imperia, Italy.
Roberto
R
Mureddu
Interventional Electrophysiology Centre, Clinica Città di Alessandria, Via Moccagatta, Alessandria, Italy; Interventional Electrophysiology Centre, Clinica San Gaudenzio di Novara, Via Bottini,3, Novara, Italy.
Paolo
P
Diotallevi
Cardiology Department, Ospedale Maggiore della Carità, Corso Mazzini, 18, Novara, Italy.
Eraldo
E
Occhetta
Cardiology Department, Ospedale Maggiore della Carità, Corso Mazzini, 18, Novara, Italy.
Andrea
A
Magnani
Cardiology Department, Ospedale San Giovanni Bosco, Piazza Donatori di sangue, Torino, Italy.
Mauro
M
Bensoni
Cardiology Department, Ospedale Santa Croce, Piazza Amedeo Ferdinando, 3, Moncalieri, TO, Italy.
Catia
C
Checchinato
Cardiology Department, Ospedale Civico, Corso Galileo Ferraris,3, Chivasso, TO, Italy.
Valentina
V
Conti
Cardiology Department, Ospedale Sant'Andrea, Via Vittorio Veneto,197, La Spezia, Italy.
Sandra
S
Badolati
Cardiology Department, Ospedali Riuniti, Via Rivalta, 29, Rivoli, TO, Italy.
Antonio
A
Mazza
Cardiac resinchronization therapy; Echocardiographyc optimization; IEGM based algorythm; Mid-septum stimulation; Optimization algorythm
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