Deneke Thomas, Lawo Thomas, von Dryander Stefan, Grewe Peter Hubert, Germing Alfried, Gorr Eduard, Hubben Peter, Mugge Andreas, Shin Dong-In, Lemke Bernd
University Heart Center Bochum, University of Bochum, Germany.
Indian Pacing Electrophysiol J. 2010 Feb 1;10(2):73-85.
Biventricular (BiV) is extensively used in the treatment of congestive heart failure but so far no recommendations for optimized programming of atrioventricular-delay (AVD) settings have been proposed. Can AVD optimization be performed using a simple formula based on non-invasive doppler-echocardiography?
25 patients (ejection fraction 30+/-8%) received BiV ICDs. Doppler-echocardiographic evaluation of diastolic and systolic flow was performed for different AVDs (30ms to 150ms) and different stimulation sites (left ventricular (LV), right ventricular and BiV). The optimal atrioventricular delay was calculated applying a simple formula based on systolic and diastolic mechanical delays determined during doppler-echocardiography.
The mean optimal AVD was calculated to be 112+/-29ms (50 to 180ms) for BiV, 95+/-30ms (65 to 150ms) for LV and 75+/-28ms (40 to 125ms) for right ventricular pacing with wide interindividual variations. Compared to suboptimal AVDs diastolic optimization improved preejection and ejection intervals independent to pacing site. Optimization of the AVD significantly increased ejection time during BiV pacing (279ms versus 266ms; p<0.05). Compared to LV or right ventricular pacing BiV pacing produced the shortest mean pre-ejection and longest ejection intervals as parameters of improved systolic ventricular contractile synchrony. Diastolic filling times were longest during BiV pacing compared to LV or RV pacing.
Individual programming of BiV pacing devices increases hemodynamic benefit when implementing the inter-individually widely varying electromechanical delays. Optimization applying a simple formula not only improves diastolic ventricular filling but also increases systolic functional parameters.
双心室起搏（BiV）广泛应用于充血性心力衰竭的治疗，但迄今为止尚未提出优化房室延迟（AVD）设置的建议。能否使用基于无创多普勒超声心动图的简单公式进行AVD优化？
25例患者（射血分数30±8%）接受了双心室植入式心脏复律除颤器（BiV ICD）。针对不同的AVD（30ms至150ms）和不同的刺激部位（左心室（LV）、右心室和双心室）进行了舒张期和收缩期血流的多普勒超声心动图评估。应用基于多普勒超声心动图测定的收缩期和舒张期机械延迟的简单公式计算最佳房室延迟。
双心室起搏的平均最佳AVD计算为112±29ms（50至180ms），左心室起搏为95±30ms（65至150ms），右心室起搏为75±28ms（40至125ms），个体差异较大。与非最佳AVD相比，舒张期优化改善了预射血和射血间期，与起搏部位无关。AVD的优化显著增加了双心室起搏期间的射血时间（279ms对266ms；p<0.05）。与左心室或右心室起搏相比，双心室起搏产生的平均预射血最短，射血间期最长，这是改善心室收缩同步性的参数。与左心室或右心室起搏相比，双心室起搏期间的舒张期充盈时间最长。
当实施个体间差异很大的机电延迟时，双心室起搏装置的个体化编程可增加血流动力学益处。应用简单公式进行优化不仅可改善心室舒张期充盈，还可增加收缩功能参数。
