Klimczak Artur, Budzikowski Adam S, Rosiak Marcin, Zielińska Marzenna, Urbanek Bożena, Bartczak Karol, Chudzik Michał, Wranicz Jerzy K
Department of Electrocardiology, Medical University of Lodz, Lodz, Poland.
Ann Noninvasive Electrocardiol. 2014 Sep;19(5):471-6. doi: 10.1111/anec.12147. Epub 2014 Mar 6.
The aim of this study was to ascertain whether individual atrioventricular delay (AVD) optimization using impedance cardiography (ICG) offers beneficial hemodynamic effects as well as improved exercise tolerance and quality of life in patients with requiring constant right ventricular pacing.
There were 37 patients with advanced AV block included in the study. Several examinations were performed at the beginning. Next, the optimization of AVD by ICG was done. The next step of the study patients have been randomized into optimal AVD group (AVDopt) or factory setting group (AVDfab). After 3 months, the follow-up all data were collected again and crossover was performed. After another 3 months, during the final follow-up all these measures were repeated.
In 87.5% patients, AVDopt were different than factory value. Cardiac output (CO), cardiac index (CI), and stroke volume (SV) were significantly (P < 0.001) higher in AVDopt group than in AVDfab group (CO: 6.0 ± 1.4 L/minute vs. 5.3 ± 1.2 L/minute; SV: 85.8 ± 25.7 mL vs.76.9 ± 22.5 mL; CI: 3.2 ± 0.7 L/minute/m(2) vs. 2.7 ± 0.6 L/minute/m(2) ). There was a statistical significant (P < 0.05) reduction of proBNP and NYHA class in patients with AVDopt compared to AVDfab (proBNP: 196.4 ± 144.7pg/mL vs. 269.4 ± 235.8 pg/mL; NYHA class: 1.7 ± 0.5 vs. 2.3 ± 0.6). Six-minute walking test was significantly (P < 0.05) higher in AVDopt group (409 ± 90 m) than in AVDfab group (362 ± 93 m). There were no statistically significant differences in echocardiographic parameters between AVDopt and AVDfab settings.
Our study results suggest that AVD optimization in patients with DDD pacemaker with ICG improves hemodynamic when compared to the default factory settings. Furthermore, optimally programmed AVD reduces BNP and improves exercise tolerance and functional class.
本研究旨在确定使用阻抗心动图（ICG）进行个体化房室延迟（AVD）优化是否能为需要持续右心室起搏的患者带来有益的血流动力学效应，以及改善运动耐量和生活质量。
37例晚期房室传导阻滞患者纳入本研究。研究开始时进行了多项检查。接下来，通过ICG对AVD进行优化。研究的下一步是将患者随机分为最佳AVD组（AVDopt）或出厂设置组（AVDfab）。3个月后，再次收集随访的所有数据并进行交叉。再过3个月，在最终随访期间重复所有这些测量。
87.5%的患者，AVDopt与出厂值不同。AVDopt组的心输出量（CO）、心脏指数（CI）和每搏输出量（SV）显著高于AVDfab组（P<0.001）（CO：6.0±1.4L/分钟 vs. 5.3±1.2L/分钟；SV：85.8±25.7mL vs. 76.9±22.5mL；CI：3.2±0.7L/分钟/平方米 vs. 2.7±0.6L/分钟/平方米）。与AVDfab组相比，AVDopt组患者的脑钠肽前体（proBNP）和纽约心脏协会（NYHA）分级有统计学显著降低（P<0.05）（proBNP：196.4±144.7pg/mL vs. 269.4±235.8pg/mL；NYHA分级：1.7±0.5 vs. 2.3±0.6）。AVDopt组的六分钟步行试验结果显著高于AVDfab组（P<0.05）（409±90米 vs. 362±93米）。AVDopt和AVDfab设置之间的超声心动图参数无统计学显著差异。
我们的研究结果表明，与默认的出厂设置相比，使用ICG对DDD起搏器患者进行AVD优化可改善血流动力学。此外，优化编程的AVD可降低BNP并改善运动耐量和功能分级。
