One year experience with automatic av delay optimization by peak endocardial acceleration

Abstract

Background Optimization of paced AV Delay is important for maximal ventricular performance. Today's practice is based on an echographic procedure, seldom performed due to follow-up time constraints. Optimal AV Delay (OAVD) estimation by Peak Endocardial Acceleration (PEA) may be performed via an automatic AV Delay Scanning followed by a programmer-based analysis of PEA data. Aim to retrospectively review effectiveness and ease of use of the OAVD estimation functionality. Methods Data were collected between 12/2003 and 11/2004 on 106 patients implanted with Sorin Biomedica Living System (pts., 62M, age 65.5±9.5y, 25 centres). OAVD estimation was performed at discharge and during follow-up (FU) at 1 month. (7 pts lost at FU). Pacers were programmed in DDD (n=66) and VDD (n=40). On 33 pts the function was executed during an effort test (submaximal 5 min cycling, at or over 110 bpm heart rate). Echo evaluation of OAVD was performed on 62 cases at discharge (30.0%), none at FU. Results OAVD was estimated in 223/238 cases (93.7%). Duration of the procedure was 101.7±35.3 s (min 64, max 188). OAVD by PEA was 137.3±31.8 ms in DDD and 122.4±36.2 ms in VDD at discharge. OAVD by echo was 143.3±39.1 ms and 129.1±44.2 ms respectively (p=ns). Correlation between PEA and echo measurements was r=0.92, p>0.001. At FU OAVD by PEA was 143.2±33.4 ms in DDD and 126.7±34.4 ms in VDD. OAVD estimation during effort was possible in 31/33 cases. All of these pts were in VDD mode. OAVD was 104.1±53.2 ms. Conclusion the function allowed easy and reliable optimization of AVD in a short time. The function may improve patient management and monitoring without extra time and cost to the follow-up. OAVD estimation during effort may be a further addition to standard patient evaluation.