Arrhythmia Center, Heart Center Ludwigshafen, Bremserstr 79, 67063 Ludwigshafen, Germany.
Clin Res Cardiol. 2010 Nov;99(11):735-41. doi: 10.1007/s00392-010-0178-y. Epub 2010 Jun 2.
Aim of this study is to evaluate reproducibility, consistency and the impact of moderate exercise workload on optimized PV and VV delays as determined by the IEGM-based QuickOpt™ method (St. Jude Medical), that was shown to produce hemodynamic performance similar to that obtained by echo-guided aortic VTI maximization.
Sixty patients with CRT-ICD (65 ± 9 years, 12% female, LVEF 28 ± 9%, 48% CAD and 52% DCM) were enrolled. IEGM-based PV/VV optimization was conducted six times: twice at rest, twice immediately after a 6-min walk test and twice following a 3-min recovery period. Timing cycle delays were programmed in accordance with the optimization results. Follow-up was performed after 1 year.
Although significant difference in heart rate was reached [68 ± 9 bpm (REST) vs. 79 ± 12 (6MWT), p < 0.001], differences were not observed between IEGM-based optimized PV/VV delays: PV(opt) = 128 ± 14 ms (REST) versus 130 ± 17 ms (6MWT) versus 129 ± 16 ms (RECOV); VV(opt) = 15 ± 24 ms (REST) versus 15 ± 22 ms (6MWT) versus 16 ± 24 ms (RECOV). During 1-year follow-up PV(opt) and VV(opt) remained stable (ΔPV(opt) = 10 ± 10 ms, ΔVV(opt) = 9 ± 11 ms).
Optimized IEGM-based timing cycle delays are independent of moderate exercise status within a particular patient but varied between patients. This supports the use of PV/VV optimization in each CRT patient.
本研究旨在评估基于心内电图（IEGM）的 QuickOptTM 方法（圣犹达医疗公司）确定的优化的 PV 和 VV 延迟的可重复性、一致性和中等运动负荷的影响，该方法已被证明可产生类似于经超声引导主动脉 VTI 最大化获得的血液动力学性能。
共纳入 60 例 CRT-ICD 患者（65±9 岁，12%为女性，LVEF 28±9%，48%为 CAD，52%为 DCM）。进行了 6 次基于 IEGM 的 PV/VV 优化：休息时进行 2 次，6 分钟步行试验后进行 2 次，恢复 3 分钟后进行 2 次。根据优化结果设定时相周期延迟。进行了为期 1 年的随访。
尽管心率存在显著差异[68±9 次/分（休息时）与 79±12 次/分（6 分钟步行试验时），p<0.001]，但基于 IEGM 的优化的 PV/VV 延迟之间没有观察到差异：PV（opt）=128±14ms（休息时）与 130±17ms（6 分钟步行试验时）与 129±16ms（恢复时）；VV（opt）=15±24ms（休息时）与 15±22ms（6 分钟步行试验时）与 16±24ms（恢复时）。在 1 年的随访期间，PV（opt）和 VV（opt）保持稳定（ΔPV（opt）=10±10ms，ΔVV（opt）=9±11ms）。
在特定患者中，基于优化的 IEGM 的时相周期延迟独立于中等运动状态，但在患者之间存在差异。这支持在每个 CRT 患者中进行 PV/VV 优化。
