Abstract
BackgroundRitter's method is a tool used to optimize AV delay in DDD pacemaker patients with normal left ventricular function only. The goal of our study was to evaluate Ritter's method in AV delay-interval optimization in patients with reduced left ventricular function.MethodsPatients with implanted DDD pacemakers and AVB III° were assigned to one of two groups according to ejection fraction (EF): Group 1 (EF > 35%) and Group 2 (EF < 35%). AV delay optimization was performed by means of radionuclide ventriculography (RNV) and application of Ritter's method.ResultsFor each of the patients examined, we succeeded in defining an optimal AV interval by means of both RNV and Ritter's method. The optimal AV delay determined by RNV correlated well with the delay found by Ritter's method, especially among those patients with reduced EF. The intra-class correlation coefficient was 0.8965 in Group 1 and 0.9228 in Group 2. The optimal AV interval in Group 1 was 190 ± 28.5 ms, and 180 ± 35 ms in Group 2.ConclusionRitter's method is also effective for optimization of AV intervals among patients with reduced left ventricular function (EF < 35%). The results obtained by RNV correlate well with those from Ritter's method. Individual programming of the AV interval is fundamentally essential in all cases.
Highlights
Ritter's method is a tool used to optimize AV delay in DDD pacemaker patients with normal left ventricular function only
We classified patients into two groups, according to left ventricular ejection fraction results obtained by echocardiography
Group 1 In a given patient, our results indicated that it was possible to define an optimal AV interval for every patient: both by radionuclide ventriculography (RNV) as well as by Ritter's method
Summary
Ritter's method is a tool used to optimize AV delay in DDD pacemaker patients with normal left ventricular function only. The goal of our study was to evaluate Ritter's method in AV delay-interval optimization in patients with reduced left ventricular function. Leman et al [16] have demonstrated that it is possible to utilize measurement of left ventricular ejection fraction and stroke volume by myocardial thallium scintigraphy as a means of AV interval optimization. Previous investigations have evaluated Ritter's method in patients with normal left ventricular ejection fractions. The goal of our study was to apply Ritter's method – until now validated only for patients with normal EF – for patients with reduced left ventricular ejection fraction (EF < 35%)
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