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Europace Advance Access published online on July 4, 2009
Europace, doi:10.1093/europace/eup173
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org.

CLINICAL RESEARCH

Cardiac output response to changes of the atrioventricular delay in different body positions and during exercise in patients receiving cardiac resynchronization therapy

Marcus Ståhlberg1,*, Morten Damgaard2, Peter Norsk2, Anders Gabrielsen1, Anders Sahlén1, Cecilia Linde1 and Frieder Braunschweig1

1 Department of Cardiology, Karolinska Institutet, Karolinska University Hospital, S-17176 Stockholm, Sweden; 2 Faculty of Health Sciences, Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark

Aims: The aim of this study was to study the haemodynamic effect of atrioventricular delay (AVD) modifications within a narrow range in different body positions and during exercise in patients receiving cardiac resynchronization therapy (CRT).

Methods: The previously optimized AVD was shortened and prolonged by 40 ms in 27 CRT patients and 9 controls without heart failure. Cardiac output (CO) was measured by inert gas rebreathing (Innocor) as the average over different body positions (left-lateral, supine, sitting, standing, and exercise). In eight CRT patients with an implantable haemodynamic monitor, the estimated pulmonary artery diastolic pressure (ePAD) was analysed.

Results: The magnitude of CO response to AVD changes was greater in CRT patients than in controls (0.25 vs. 0.20 L/min, P < 0.05), varied substantially between individuals (range: 0.12–0.56 L/min), and correlated with left atrial size (r = 0.61, P < 0.001). On average, AVD shortening decreased CO slightly (0.07 ± 0.17 L/min) and increased ePAD (1.1 ± 0.8 mmHg, both P < 0.05), whereas prolongation had no significant effect.

Conclusion: The haemodynamic response to AVD modifications within a narrow range is larger in CRT patients than in normal controls and varies substantially between individuals. These findings suggest that optimal AVD tuning is clinically important in selected patients.

Key Words: Cardiac resynchronization therapy, Heart failure, Atrioventricular delay, Cardiac output, Body position, Exercise

* Corresponding author. Tel: +46 8 5177 0000, Fax: +46 8 311044, Email: marcus.stahlberg{at}ki.se

Manuscript submitted 15 March 2009. Accepted after revision 1 June 2009.


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