Utilization of the ics3000 programmer to measure interatrial conduction intervals and to optimize the av delay in patients with biventricular pace-makers and icds irrespective of make and model

Abstract

The current Biotronik ICS3000 programmer software enables recording of a filtered esophageal left atrial electrogram (LAE) in addition to the surface ECG. It can be utilized to measure interatrial conduction intervals (IACT) in patients with DDD systems irrespective of make and model. Aims To study relations between interatrial conduction intervals and optimal Doppler AV delay (AVD) in biventricular paced congestive heart failure (CHF) patients and to test ICS3000 for simplified AVD optimization. Methods LAE and transmitral flow (TMF) were recorded simultaneously to measure determinants of the optimal AV delay (AVD) in 32 CHF patients (21 Medtronic, 11 Biotronik DDD or ICD systems: 20m, 12f, 65,3±10,4y, NYHA III, QRS150ms): Programming unphysiologically long AVD in VDD operation, 1. IACT was AVD minus interval between left atrial deflection (LA) and ventricular stimulus (Sv). 2. Duration of undisturbed left atrial electromechanical contribution (LA-EAClong) was measured between LA and end of atrial contribution (EAC) in TMF. During unpysiologically short AVD in DDD operation we measured 3. IACT between atrial stimulus and LA and 4. the latency of prematurely ending atrial contribution (Sv-EACshort) between Sv and EAC in TMF. In VDD and DDD operation, optimal AVD was calculated by the formula AVDoptimal = IACT + LA-EAClong - Sv-EACshort . Results Results are demonstrated in the table as mean±SD: View this table: Conclusions 1. Optimal AVD in CHF patients was found to be on average 45ms longer than individual interatrial conduction interval. Thus, 2. irrespective of make and model, the ICS3000 programmer based LEA can be used to approximate the optimal AVD in biventricular pacing by adjusting about 45ms between left atrial deflection and ventricular stimulus.