National Heart and Lung Institute, Imperial College London, Hammersmith Hospital, London, UK.
Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK.
Pacing Clin Electrophysiol. 2022 Apr;45(4):461-470. doi: 10.1111/pace.14434. Epub 2022 Jan 28.
Hemodynamically optimal atrioventricular (AV) delay can be derived by echocardiography or beat-by-beat blood pressure (BP) measurements, but analysis is labor intensive. Laser Doppler perfusion monitoring measures blood flow and can be incorporated into future implantable cardiac devices. We assess whether laser Doppler can be used instead of BP to optimize AV delay.
Fifty eight patients underwent 94 AV delay optimizations with biventricular or His-bundle pacing using laser Doppler and simultaneous noninvasive beat-by-beat BP. Optimal AV delay was defined using a curve of hemodynamic response to switching from AAI (reference state) to DDD (test state) at several AV delays (40-320 ms), with automatic quality control checking precision of the optimum. Five subsequent patients underwent an extended protocol to test the impact of greater numbers of alternations on optimization quality.
55/94 optimizations passed quality control resulting in an optimal AV delay on laser Doppler similar to that derived by BP (median absolute deviation 12 ms). An extended protocol with increasing number of replicates consistently improved quality and reduced disagreement between laser Doppler and BP optima. With only five replicates, no optimization passed quality control, and the median absolute deviation would be 29 ms. These improved progressively until at 50 replicates, all optimizations passed quality control and the median absolute deviation was only 13 ms.
Laser Doppler perfusion produces hemodynamic optima equivalent to BP. Quality control can be automatic. Adding more replicates, consistently improves quality. Future implantable devices could use such methods to dynamically and reliably optimize AV delays.
通过超声心动图或逐搏血压（BP）测量可以得出血流动力学最佳的房室（AV）延迟，但分析过程繁琐。激光多普勒灌注监测可测量血流，未来可将其纳入可植入心脏设备中。我们评估是否可以使用激光多普勒代替 BP 来优化 AV 延迟。
58 例患者接受了 94 次双心室或希氏束起搏的 AV 延迟优化，使用激光多普勒和同时进行的无创逐搏 BP 测量。通过切换到 AAI（参考状态）到 DDD（测试状态）的几个 AV 延迟（40-320 ms）的血流动力学反应曲线来定义最佳 AV 延迟，自动质量控制检查最佳值的精度。随后的 5 例患者进行了扩展方案测试，以测试更多切换对优化质量的影响。
55/94 次优化通过质量控制，在激光多普勒上获得的最佳 AV 延迟与 BP 相似（中位数绝对偏差 12 ms）。随着复制次数的增加，扩展方案始终提高了质量并减少了激光多普勒和 BP 最佳值之间的差异。只有 5 次重复时，没有优化通过质量控制，中位数绝对偏差为 29 ms。这些结果逐渐改善，直到 50 次重复时，所有优化均通过质量控制，中位数绝对偏差仅为 13 ms。
激光多普勒灌注产生的血流动力学最佳值与 BP 相当。质量控制可以是自动的。增加更多的重复次数可以持续提高质量。未来的可植入设备可以使用这些方法来动态和可靠地优化 AV 延迟。
