Europace Advance Access published online on November 23, 2007
Europace, doi:10.1093/europace/eum257
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Should we use the rate-adaptive AV delay in cardiac resynchronization therapy-pacing?
1 The Medical Division, Charité University Medical Centre, Berlin, Germany; 2 The Rostock University Hospital, Clinic for Internal Medicine, Rostock, Germany
Aims: Recommendations for programming the rate-adaptive AV delay in CRT.
Methods and results: In cases of continual biventricular pacing, the optimal AV delay in CRT (AVDopt) is the net effect of the pacemaker-related interatrial conduction time (IACT), duration of the left-atrial electromechanical action (LA-EAClong), and the duration of the left-ventricular latency period (SV-EACshort). It can be calculated by AVDopt = IACT+LA-EAClong–SV-EACshort. We measured these three components in 20 CRT–ICD patients during rest and submaximal ergo metric exercise (71 ± 9 W) resulting in a 22.5 ± 9.6 bpm rate increase. IACT and SV-EACshort did not reveal significant differences. LA-EAClong, however, varied significantly by –10.7 ± 16.1 ms (P = 0.008) during exercise. In contrast to AVDoptVDD, there was a significant difference in AVDoptDDD of –8.8 ± 14.5 ms (P = 0.014) between the resting and submaximal exercise conditions. In DDD pacing, AVDopt was shortened by 2.6 ms/10 bpm.
Conclusion: In consideration of the findings of the studies performed to date, the rate-adaptive AV delay should be deactivated.
Key Words: Rate-adaptive AV delay, CRT, AV delay optimization
* Corresponding author: Charité—Campus Mitte Medizinische Klinik mit Schwerpunkt Kardiologie, Angiologie, Pneumologie Schumannstraße 20/21, D—10117 Berlin, Germany. Tel: +49 30 450 613 145 ; fax: +49 30 450 513 904.E-mail address: christoph.melzer{at}charite.de
Manuscript submitted 11 June 2007. Revision received 29 October 2007. Accepted after revision 29 October 2007.
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