Echocardiography-Guided Pacemaker Optimization and Radial Artery Tonometry

Abstract

Background Biventricular (Biv) pacemaker optimization is underused because of time and echo skill required. We evaluated radial artery tonometry during echo-guided Biv optimization of atrioventricular (AV) and interventricular (VV) delays. Methods and Results A total of 60 patients (67 ± 10 years) underwent simultaneous radial artery tonometry and echocardiography after Biv implant at baseline, short AV delay, and optimal AV delay. Twenty of these also underwent VV optimization. Optimal AV delay was determined by ejection duration (E-dur) of left ventricular (LV) outflow tract by pulsed-waved (PW) Doppler (LV E-dur) and mitral inflow PW Doppler pattern and optimal VV delay by LV E-dur and tissue Doppler. E-dur was also measured from radial artery pulse wave (RA E-dur). AV optimization improved LV E-dur from 249 ± 35 to 260 ± 38 ms ( P < .01) and RA E-dur from 276 ± 31 ms to 284 ± 32 ms ( P = .02). Correlation between LV E-dur and by RA E-dur was 0.83 (95% CI 0.75–0.92). RA E-dur was 282.53 ± 30 at baseline, 286.65 ± 36 at optimal AV delay ( P < .04 vs. baseline) and 286.90 ± 35 ms ( P < .04 vs. baseline) at optimal AV and VV delay in those who underwent VV optimization. Conclusions AV and VV optimization by echocardiography produces significant improvement in LV E-dur and RA E-dur. Radial artery tonometry may provide a simple noninvasive method to assist in AV delay optimization.