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Europace Advance Access originally published online on August 27, 2008
Europace 2008 10(10):1161-1169; doi:10.1093/europace/eun216
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2008. For permissions please email: journals.permissions@oxfordjournals.org
The online version of this article has been published under an open access model. Users are entitled to use, reproduce, disseminate, or display the open access version of this article for non-commercial purposes provided that the original authorship is properly and fully attributed; the Journal, Learned Society and Oxford University Press are attributed as the original place of publication with correct citation details given; if an article is subsequently reproduced or disseminated not in its entirety but only in part or as a derivative work this must be clearly indicated. For commercial re-use, please contact journals.permissions@oxfordjournals.org

Cardiac resynchronization therapy

Cardiac resynchronization therapy during rest and exercise: comparison of two optimization methods

Cinzia Valzania1,2,*, Maria J. Eriksson3,4, Giuseppe Boriani2 and Fredrik Gadler1,5

1 Department of Medicine, Division of Cardiology, Karolinska Institutet, Stockholm, Sweden; 2 Institute of Cardiology, University of Bologna, Bologna, Italy; 3 Department of Clinical Physiology, Karolinska University Hospital, Stockholm, Sweden; 4 Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; 5 Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden

Aims: Optimal exercise programming of cardiac resynchronization therapy (CRT) devices is unknown. We aimed to: (i) investigate variations in optimal atrioventricular (AV) and interventricular (VV) delays from rest to exercise, assessed by both echocardiography and an automated intracardiac electrogram (IEGM) method; (ii) evaluate the acute haemodynamic impact of CRT optimization performed during exercise.

Methods and results: Twenty-four heart failure patients, previously implanted with a CRT defibrillator, underwent AV and VV delay optimization, by echocardiography and IEGM methods, both at rest and during supine bicycle exercise. Rest-to-exercise variations in optimal VV delay were observed in 58% of patients. Conversely, optimal AV delay did not change during exercise compared with rest. Substantial agreement of AV and VV delays was observed between both the optimization methods. Exercise optimization of VV delay by either method improved intraventricular dyssynchrony and increased aortic velocity time integral compared with the resting setting (P < 0.001).

Conclusion: In patients implanted with a CRT device, optimal VV delay varied considerably from rest to exercise, while AV delay did not change. Re-assessment of the optimal pacing configuration during supine exercise, by echocardiography as well as IEGM methods, yielded an additional haemodynamic benefit to that provided by resting optimization.

Key Words: Cardiac resynchronization therapy, Optimization, Exercise, Echocardiography, Intracardiac electrogram

* Corresponding author. Tel: +39 (0) 51 344859; fax: +39 (0) 51 349858. E-mail address: cinzia.valzania2{at}studio.unibo.it

Manuscript submitted 10 April 2008. Accepted after revision 19 July 2008.


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[Abstract] [Full Text] [PDF]


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