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Europace Advance Access originally published online on March 14, 2007
Europace 2007 9(5):319-324; doi:10.1093/europace/eum022
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© The European Society of Cardiology 2007. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

PACEMAKER THERAPY

How can the rate-adaptive atrioventricular delay be programmed in atrioventricular block pacing?

Christoph Melzer1,*, Thomas Körber2, Heinz Theres1, Christoph A. Nienaber2, Gert Baumann1 and Bruno Ismer2

1 Charité—Campus Mitte, Medizinische Klinik mit Schwerpunkt, Kardiologie, Angiologie, Pneumologie, Schumannstraße 20/21, D—10117 Berlin, Germany; 2 Rostock University Hospital, Clinic for Internal Medicine, Rostock, Germany

Aim: To optimize recommendations for programming of the rate-adaptive atrioventricular (AV) delay.

Methods and results: Optimal AV delay (AVDopt) is the net effect of the pacemaker-related interatrial conduction time (IACT), duration of the left-atrial electromechanical action (LA-EAClong) and duration of left-ventricular latency (SV-EACshort). It can be calculated by AVDopt = IACT + LA-EAClong–SV-EACshort. We measured these three components in 20 DDD pacemaker patients (EF >45%) with the third degree AV block (AVB) at rest and submaximal ergometric exercise load of 71 ± 9 W which resulted in a 31.5 ± 9.9 bpm rate increase. Between exercise and rest, the components of and the final AVDopt showed no significant differences. Interatrial conduction time in VDD and DDD pacing varied by 2.3 ± 8.4 ms and 1.4 ± 8.8 ms, respectively, SV-EACshort changed by –2.6 ± 21.8 ms and AVDopt by –3.5 ± 33.3 ms and –4.3 ± 37.8 ms in VDD and DDD operation, respectively. The greatest variation was of LA-EAClong by –8.4 ± 32.7 ms. Linear regressions of the rate-dependent variations ({Delta}f) in VDD operation yielded {Delta}IACT(f) = 0.04{Delta}f + 0.95 ms, {Delta}LA-EAClong = –0.59{Delta}f + 10.1 ms, and {Delta}SV – EACshort = 0.14{Delta}f –7.2 ms which resulted in {Delta}AVDopt = –0.69{Delta}f + 18.2 ms.

Conclusion: A recommendation for programming of rate-adaptive AV delay in AV block patients cannot be given.

Key Words: Rate-adaptive AV delay, DDD pacemaker, AV delay optimization

* Corresponding author. Tel: +49 30 450 613 145; fax: +49 30 450 513 904. E-mail address: christoph.melzer{at}charite.de

Manuscript submitted 2 May 2006. Accepted after revision 10 December 2006.


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C. Melzer, H. Bondke, T. Korber, C. A. Nienaber, G. Baumann, and B. Ismer
Should we use the rate-adaptive AV delay in cardiac resynchronization therapy-pacing?
Europace, January 1, 2008; 10(1): 53 - 58.
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