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• W2024271618 abstract "Atrioventricular (AV) delay optimization is important for patients (Pts) with DDD pacemakers, but it is essential in heart failure Pts with cardiac resynchronization therapy (CRT), since they require an optimal AV delay to accomplish resynchronization. Mitral inflow A-wave (Aw) Doppler pattern (atrial transport) is used for AV optimization, based on the concept that AV is optimal when non-truncated atrial transport ends just before left ventricular contraction starts. Thus, a truncated Aw would indicate a non-physiological AV delay with overlapping contractions of left atrium (LA) and left ventricle (LV), causing pacemaker syndrome (PMS). It was the objective of this study to determine if Aw morphology is sufficient to establish presence or absence of LA/LV contraction overlap. Methods: Pts with DDD and CRT devices were studied by echo-Doppler. AV sequential pacing was done at AVs from 240 to 60 ms in 20 ms steps. At each AV, Aw morphology was evaluated for truncation. Since mitral regurgitation (MR) starts only when LV pressure exceeds that of LA, it was hypothesized that with short AV, LA contraction could counteract LV contraction, delaying the time of onset of MR (MRt). Thus, MRt delay is an indicator of LA/LV contraction overlap. MRt was measured from ventricular pacing pulse to the onset of MR. Results: Thirty six patients (Pts) (56% males, ages from 19 to 89) were included. Twenty six had DDD and ten CRT pacemakers. MR was detectable in all but one Pt. MRt increased from a mean of 63ms at the longest AV to 146 ms at the shortest AV (P< 0.001). Short AVs postponed MRt in all Pts, with significant AV/MRt regressions (all P values <0.01). Figure (figure1) shows lengthening of MRt (arrows) at short AV as compared to long AV, but with preserved Aw. Sixty-eight percent of Pts with short AVs and lengthened MRt (consistent with overlapping LA/LV contractions) had apparently normal Aw. Conclusions: 1. Mitral Doppler Aw is inadequate for AV optimization. 2. AV intervals with non-truncated mitral Doppler Aw, but with delayed MRt are non-physiological, suggesting LA/LV contraction overlap, compatible with PMS." @default.
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• W2024271618 date "2009-08-01" @default.
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• W2024271618 title "Value of Mitral Doppler Inflow Pattern to Optimize Atrioventricular Delay in Dual (DDD) and Triple Chamber (CRT) Pacemakers" @default.
• W2024271618 doi "https://doi.org/10.1016/j.cardfail.2009.06.227" @default.
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