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Kyriacou A, Rajkumar CA, Pabari PA, et al. Distinct impacts of heart rate and right atrial-pacing on left atrial mechanical activation and optimal AV delay in CRT. Pacing Clin Electrophysiol. 2018;doi: 10.1111/pace.13401.
Kyriacou, A., Rajkumar, C. A., Pabari, P. A., Sohaib, S. M. A., Willson, K., Peters, N. S., Lim, P. B., Kanagaratnam, P., Hughes, A. D., Mayet, J., Whinnett, Z. I., & Francis, D. P. (2018). Distinct impacts of heart rate and right atrial-pacing on left atrial mechanical activation and optimal AV delay in CRT. Pacing and clinical electrophysiology : PACE, . https://doi.org/10.1111/pace.13401
Kyriacou, Andreas, et al. "Distinct impacts of heart rate and right atrial-pacing on left atrial mechanical activation and optimal AV delay in CRT." Pacing and clinical electrophysiology : PACE vol. (2018). doi: https://doi.org/10.1111/pace.13401
Kyriacou A, Rajkumar CA, Pabari PA, Sohaib SMA, Willson K, Peters NS, Lim PB, Kanagaratnam P, Hughes AD, Mayet J, Whinnett ZI, Francis DP. Distinct impacts of heart rate and right atrial-pacing on left atrial mechanical activation and optimal AV delay in CRT. Pacing Clin Electrophysiol. 2018 Jun 01; doi: 10.1111/pace.13401. Epub 2018 Jun 01. PMID: 29856077; PMCID: PMC6099378.
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Pacing Clin Electrophysiol. 2018 Jun 01; doi: 10.1111/pace.13401. Epub 2018 Jun 01.

Distinct impacts of heart rate and right atrial-pacing on left atrial mechanical activation and optimal AV delay in CRT.

Pacing and clinical electrophysiology : PACE

Andreas Kyriacou, Christopher A Rajkumar, Punam A Pabari, S M Afzal Sohaib, Keith Willson, Nicholas S Peters, Phang B Lim, Prapa Kanagaratnam, Alun D Hughes, Jamil Mayet, Zachary I Whinnett, Darrel P Francis

Affiliations

  1. The Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.
  2. International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London, London, W12 0HS, UK.

PMID: 29856077 PMCID: PMC6099378 DOI: 10.1111/pace.13401

Abstract

BACKGROUND: Controversy exists regarding how atrial activation mode and heart rate affect optimal atrioventricular (AV) delay in cardiac resynchronization therapy. We studied these questions using high-reproducibility hemodynamic and echocardiographic measurements.

METHODS: Twenty patients were hemodynamically optimized using noninvasive beat-to-beat blood pressure at rest (62 ± 11 beats/min), during exercise (80 ± 6 beats/min), and at three atrially paced rates: 5, 25, and 45 beats/min above rest, denoted as A

RESULTS: During atrial sensing, raising heart rate shortened optimal AV delay by 25 ± 6 ms (P < 0.001). During atrial pacing, raising heart rate from A

CONCLUSIONS: Hemodynamic optimal AV delay shortens with elevation of heart rate. It lengthens on switching from atrial-sensed to atrial-paced at the same rate, and echocardiography shows this sensed-paced difference in optima results from a sensed-paced difference in atrial electromechanical delay. The reason for the widening of the sensed-paced difference in AV optimum may be physiological stimuli (e.g., adrenergic drive) advancing left atrial contraction during exercise but not with fast atrial pacing.

© 2018 The Authors. Pacing and Clinical Electrophysiology published by Wiley Periodicals, Inc.

Keywords: atrioventricular delay; cardiac resynchronization therapy; electrophysiology-clinical; heart failure; optimization

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