Cardiac Resynchronization Therapy and AV Optimization: A Hemodynamic Evaluation with Non-Invasive Techniques

Abstract

Aim: This study aimed to evaluate the impact of atrioventricular (AV) optimization of biventricular pacemakers on cardiac hemodynamic parameters, particularly mitral inflow and aortic valve velocity-time integral (VTI), using impedance cardiography (ICG) and echocardiography in patients with symptomatic systolic heart failure and left bundle branch block unresponsive to cardiac resynchronization therapy. Material and Methods: The study included 20 patients, 10 (50%) males and 10 (50%) females, aged between 18 and 80 years, who had undergone biventricular pacemaker implantation and did not have aortic stenosis, decompensated heart failure, or echocardiographically optimized AV interval measurements. Hemodynamic values were calculated following ICG measurements. Results: The mean AV delay time did not change after AV optimization (p=0.685). However, optimization led to a statistically significant increase in mitral inflow VTI and aortic valve VTI (both p<0.001). No significant post-optimization variations were observed in hemodynamic parameters obtained by ICG compared to baseline measurements. There was a statistically significant decrease in heart rate when compared to the pre-optimization values (p=0.003). Conclusion: This study identified a significant enhancement in echocardiographic parameters attributable to AV optimization. The results obtained with AV optimization were consistent with those of large-scale randomized studies. However, further comprehensive studies are needed to assess the individual patient responses and long-term outcomes.

Keywords

• Cardiomyopathy
• cardiac resynchronization therapy
• artificial pacemaker
• impedance cardiography
• echocardiography

Kardiyak Resenkronizasyon Tedavisi ve AV Optimizasyonu: Non-İnvaziv Tekniklerle Hemodinamik Değerlendirme

Abstract

Amaç: Bu çalışmada, semptomatik sistolik kalp yetmezliği ve kardiyak resenkronizasyon tedavisine yanıt vermeyen sol dal bloğu olan hastalarda, biventriküler kalp pillerinin atriyoventriküler (AV) optimizasyonunun, özellikle mitral doluş ve aort kapak hız-zaman integrali (VTI) olmak üzere, kardiyak hemodinamik parametreler üzerindeki etkisinin impedans kardiyografi (ICG) ve ekokardiyografi (ECHO) kullanarak değerlendirilmesi amaçlanmıştır. Gereç ve Yöntemler: Çalışmaya, biventriküler kalp pili implantasyonu yapılmış olan ve aort darlığı, dekompanse kalp yetmezliği bulunmayan veya daha önce ekokardiyografik olarak AV interval optimizasyonu yapılmamış yaşları 18 ile 80 arasında, 10 (%50) erkek ve 10 (%50) kadın olmak üzere 20 hasta dahil edildi. Hemodinamik değerler, ICG ölçümlerini takiben hesaplandı. Bulgular: AV optimizasyonu sonrası ortalama AV gecikme süresi değişmemiştir (p=0,685). Bununla birlikte, optimizasyon, mitral doluş VTI ve aort kapak VTI bakımından istatistiksel olarak anlamlı bir artışa neden olmuştur (her iki p<0,001). ICG ile elde edilmiş olan hemodinamik parametrelerde, başlangıç ölçümleri ile karşılaştırıldığında optimizasyon sonrası anlamlı bir değişim gözlenmemiştir. Kalp hızında ise optimizasyon öncesi değerler ile karşılaştırıldığında istatistiksel olarak anlamlı bir azalma olduğu saptanmıştır (p=0,003). Sonuç: Bu çalışma, ekokardiyografik parametrelerde AV optimizasyonuna atfedilebilecek önemli bir iyileşme tespit etmiştir. AV optimizasyonu ile elde edilen sonuçlar, büyük ölçekli randomize çalışmalar ile tutarlılık göstermektedir. Bununla birlikte, bireysel hasta yanıtları ve uzun vadeli etkiler açısından değerlendirmek için daha kapsamlı çalışmalara ihtiyaç vardır.

Keywords

• Kardiyomiyopati
• kardiyak resenkronizasyon tedavisi
• yapay kalp pili
• empedans kardiyografi
• ekokardiyografi

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