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Indian Pacing Electrophysiol J. 2016 Mar-Apr;16(2):59-65. doi: 10.1016/j.ipej.2016.05.001. Epub 2016 Jun 3.

Comparison between IEGM-based approach and echocardiography in AV/PV and VV delay optimization in CRT-D recipients (Quicksept study).

Author information

1
Cardiology Department, Ospedale Maria Vittoria, Via Cibrario 72, Torino, Italy. Electronic address: stent.icd@gmail.com.
2
Cardiology Department, Ospedale SS Annunziata, Via Felice Migliori, 1, Cosenza, Italy.
3
Cardiology Department, Ospedale Maria Vittoria, Via Cibrario 72, Torino, Italy.
4
Cardiology Department, Ospedale Civile, Piazza Credenza, 2, Ivrea, TO, Italy; Cardiology Department, Ospedale di Cirie', Via Battitore, 79, Cirie', TO, Italy.
5
Cardiology Department, Ospedale Civile, Piazza Credenza, 2, Ivrea, TO, Italy.
6
Cardiology Department, Ospedale Santa Corona, Via XXV Aprile, 38, Pietra Ligure, SV, Italy.
7
Cardiology Department, Ospedale di Imperia, Via Sant'Agata,57, Imperia, Italy.
8
Interventional Electrophysiology Centre, Clinica Città di Alessandria, Via Moccagatta, Alessandria, Italy; Interventional Electrophysiology Centre, Clinica San Gaudenzio di Novara, Via Bottini,3, Novara, Italy.
9
Cardiology Department, Ospedale Maggiore della Carità, Corso Mazzini, 18, Novara, Italy.
10
Cardiology Department, Ospedale San Giovanni Bosco, Piazza Donatori di sangue, Torino, Italy.
11
Cardiology Department, Ospedale Santa Croce, Piazza Amedeo Ferdinando, 3, Moncalieri, TO, Italy.
12
Cardiology Department, Ospedale Civico, Corso Galileo Ferraris,3, Chivasso, TO, Italy.
13
Cardiology Department, Ospedale Sant'Andrea, Via Vittorio Veneto,197, La Spezia, Italy.
14
Cardiology Department, Ospedali Riuniti, Via Rivalta, 29, Rivoli, TO, Italy.

Abstract

BACKGROUND:

AtrioVentricular (AV) and InterVentricular (VV) delay optimization can improve ventricular function in Cardiac Resynchronization Therapy (CRT) and is usually performed by means of echocardiography. St Jude Medical has developed an automated algorhythm which calculates the optimal AV and VV delays (QuickOpt™) based on Intracardiac ElectroGrams, (IEGM), within 2 min. So far, the efficacy of the algorhythm has been tested acutely with standard lead position at right ventricular (RV) apex. Aim of this project is to evaluate the algorhythm performance in the mid- and long-term with RV lead located in mid-septum.

METHODS:

AV and VV delays optimization data were collected in 13 centers using both echocardiographic and QuickOpt™ guidance in CRTD implanted patients provided with this algorhythm. Measurements of the aortic Velocity Time Integral (aVTI) were performed with both methods in a random order at pre-discharge, 6-month and 12-month follow-up.

RESULTS:

Fifty-three patients were studied (46 males; age 68 ± 10y; EF 28 ± 7%). Maximum aVTI obtained by echocardiography at different AV delays, were compared with aVTI acquired at AV delays suggested by QuickOpt. The AV Pearson correlations were 0.96 at pre-discharge, 0.95 and 0,98 at 6- and 12- month follow-up respectively. After programming optimal AV, the same approach was used to compare echocardiographic aVTI with aVTI corresponding to the VV values provided by QuickOpt. The VV Pearson Correlation were 0,92 at pre-discharge, 0,88 and 0.90 at 6-month and 12- month follow-up respectively.

CONCLUSIONS:

IEGM-based optimization provides comparable results with echocardiographic method (maximum aVTI) used as reference with mid-septum RV lead location.

KEYWORDS:

Cardiac resinchronization therapy; Echocardiographyc optimization; IEGM based algorythm; Mid-septum stimulation; Optimization algorythm

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