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Europace Advance Access published online on November 4, 2009
Europace, doi:10.1093/europace/eup337
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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

A prospective comparison of echocardiography and device algorithms for atrioventricular and interventricular interval optimization in cardiac resynchronization therapy

Ravindu Kamdar, Evelyn Frain, Fiona Warburton, Laura Richmond, Victoria Mullan, Thomas Berriman, Glyn Thomas, Joanna Tenkorang, Mehul Dhinoja, Mark Earley, Simon Sporton and Richard Schilling*

Department of Cardiology, St Bartholomew's Hospital, Barts and the London NHS Trust, Dominion House, 60 Bartholomew Close, West Smithfield, EC1A 7BE London, UK

Aims: Echocardiographic optimization of atrioventricular (AV) and interventricular (VV) intervals in cardiac resynchronization therapy (CRT) is costly, time-consuming, and requires skill and expertise so is usually undertaken only in ‘non-responder’ patients. An algorithm in St Jude Medical CRT devices (QuickOptTM) claims to optimize these settings automatically. The aim of this study was to compare the two optimization techniques.

Methods and results: Optimization of AV and VV intervals was performed a month after CRT device implantation in 26 patients with heart failure, first by echocardiography then by QuickOpt. The left ventricular outflow tract (LVOT) velocity–time integral (VTI) was measured after optimization by each method. Agreement between the optimization methods was assessed by the Bland–Altman analysis and correlation by Pearson's correlation coefficient. There was good correlation between the LVOT VTI following optimization by both methods (R2 = 0.77, P < 0.001). However, agreement between the two methods was poor, with 15 of 26 and 10 of 26 patients having a >20 ms difference in the optimal AV and VV interval values, respectively. Left ventricular outflow tract VTI was significantly better (22 of 26 patients; P < 0.001) in patients optimized by echocardiography than by QuickOpt.

Conclusion: There is a poor agreement in optimal AV and VV intervals determined by echocardiography and QuickOpt, with echocardiographic optimization giving a superior haemodynamic outcome.

Key Words: Cardiac resynchronization therapy, Heart failure, AV delay optimization, VV delay optimization, Echocardiography, QuickOpt algorithm

* Corresponding author. Tel: +44 20 7601 8639, Fax: +44 20 7601 8627, Email: r.schilling{at}qmul.ac.uk

Manuscript submitted 9 June 2009. Accepted after revision 3 October 2009.


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