Centennial Heart Cardiovascular Associates, Nashville, Tennessee, USA.
J Cardiovasc Electrophysiol. 2010 Nov;21(11):1226-32. doi: 10.1111/j.1540-8167.2010.01807.x.
Electrocardiographic AV Delay Adjustment.
Optimization of the atrioventricular (AV) delay (AVD) may result in an improvement in cardiac resynchronization therapy (CRT) outcome. Previous studies have shown positive correlation between interatrial conduction time measured invasively during the implant procedure and optimal AVD determined postimplant using Doppler echocardiography. We hypothesized that the optimal AVD can be predicted noninvasively from surface electrocardiogram (ECG).
The optimal sensed (SAV) and paced (PAV) AVDs were determined for CRT patients (n = 63) by programming different AVDs (in 20 ms steps, in random sequence) and evaluating Doppler images of the mitral flow (iterative method). The time intervals between atrial sensing (As) and pacing (Ap) to the end of the P-wave (Pend) and to the right ventricular sensing (RVs) were measured from 5 ECG leads (limb, V1, and V3) and device telemetry during sinus rhythm and atrial pacing.
Optimal SAV was 120 ± 30 ms and correlated with As-Pend (R = 0.69, P < 0.0001) and As-RVs (R = 0.45, P = 0.0003). Optimal PAV was 172 ± 38 ms and correlated with Ap-Pend (R = 0.65, P < 0.0001) and Ap-RVs (R = 0.60, P < 0.0001). Regression analysis suggested a simple method of AVD adjustment by pacing the ventricles 40 ms after the end of the sensed P-wave or 30 ms after the end of the paced P-wave but not at the expense of biventricular capture. Such a method would have resulted in significantly lower deviation from echo-optimal AVDs compared with programming fixed values.
A simple method of providing 30-40 ms separation between the end of the P-wave and ventricular pacing pulse can be used to approximate echocardiographically optimal AV delays.
未加标签：心电图房室延迟调整。
背景：优化房室（AV）延迟（AVD）可能会改善心脏再同步治疗（CRT）的效果。先前的研究表明，在植入过程中通过侵入性测量的房间传导时间与使用多普勒超声心动图在植入后确定的最佳 AVD 之间存在正相关。我们假设可以通过体表心电图（ECG）无创地预测最佳 AVD。
方法：通过编程不同的 AVD（以 20 ms 的步长，随机顺序）并评估二尖瓣血流的多普勒图像（迭代方法），为 CRT 患者（n = 63）确定最佳感知（SAV）和起搏（PAV）AVD。在窦性节律和心房起搏期间，从 5 个 ECG 导联（肢体、V1 和 V3）和设备遥测记录心房感知（As）和起搏（Ap）到 P 波末端（Pend）和右心室感知（RVs）的时间间隔。
结果：最佳 SAV 为 120 ± 30 ms，与 As-Pend（R = 0.69，P < 0.0001）和 As-RVs（R = 0.45，P = 0.0003）相关。最佳 PAV 为 172 ± 38 ms，与 Ap-Pend（R = 0.65，P < 0.0001）和 Ap-RVs（R = 0.60，P < 0.0001）相关。回归分析表明，一种简单的 AVD 调整方法是在感知 P 波结束后起搏心室 40 ms 或在起搏 P 波结束后起搏心室 30 ms，但不会影响双心室捕获。与编程固定值相比，这种方法将导致与超声心动图最佳 AVD 的偏差显著降低。
结论：可以使用一种简单的方法，即在 P 波结束和心室起搏脉冲之间提供 30-40 ms 的间隔，以近似超声心动图最佳的 AV 延迟。
