1st Department of Internal Medicine-Cardiology and Angiology, University Hospital and Charles University Faculty of Medicine, Hradec Králové, Czech Republic.
Cardiology Department, Liberec Regional Hospital, Liberec, Czech Republic.
PLoS One. 2022 Sep 26;17(9):e0275276. doi: 10.1371/journal.pone.0275276. eCollection 2022.
Device-based algorithms offer the potential for automated optimization of cardiac resynchronization therapy (CRT), but the process for accepting them into clinical use is currently still ad-hoc, rather than based on pre-clinical and clinical testing of specific features of validity. We investigated how the QuickOpt-guided VV delay (VVD) programming performs against the clinical and engineering heuristic of QRS complex shortening by CRT.
A prospective, 2-center study enrolled 37 consecutive patients with CRT. QRS complex duration (QRSd) was assessed during intrinsic atrioventricular conduction, synchronous biventricular pacing, and biventricular pacing with QuickOpt-proposed VVD. The measurements were done manually by electronic calipers in signal-averaged and magnified 12-lead QRS complexes.
Native QRSd was 174 ± 22 ms. Biventricular pacing with empiric AVD and synchronous VVD resulted in QRSd 156 ± 20 ms, a significant narrowing from the baseline QRSd by 17 ± 27 ms, P = 0.0003. In 36 of 37 patients, the QuickOpt algorithm recommended left ventricular preexcitation with VVD of 42 ± 18 ms (median 40 ms; interquartile range 30-55 ms, P <0.00001). QRSd in biventricular pacing with QuickOpt-based VVD was significantly longer compared with synchronous biventricular pacing (168 ± 25 ms vs. 156 ± 20 ms; difference 12 ± 11ms; P <0.00001). This prolongation correlated with the absolute VVD value (R = 0.66, P <0.00001).
QuickOpt algorithm systematically favours a left-preexcitation VVD which translates into a significant prolongation of the QRSd compared to synchronous biventricular pacing. There is no reason to believe that a manipulation that systematically widens QRSd should be considered to optimize physiology. Device-based CRT optimization algorithms should undergo systematic mechanistic pre-clinical evaluation in various scenarios before they are tested in large clinical studies.
基于设备的算法为心脏再同步治疗（CRT）的自动优化提供了潜力，但目前接受它们进入临床使用的过程仍然是临时性的，而不是基于对具体有效性特征的临床前和临床测试。我们研究了 QuickOpt 指导的房室延迟（VVD）编程如何针对 CRT 的 QRS 复合体缩短的临床和工程启发式进行操作。
一项前瞻性、2 中心研究纳入了 37 例连续接受 CRT 的患者。在固有房室传导、双心室同步起搏和双心室起搏时，使用 QuickOpt 提出的 VVD，评估 QRS 复合体持续时间（QRSd）。使用电子卡尺在信号平均和放大的 12 导联 QRS 复合体中手动进行测量。
固有 QRSd 为 174 ± 22 ms。双心室起搏时采用经验性 AVD 和同步 VVD，QRSd 为 156 ± 20 ms，与基线 QRSd 相比显著变窄 17 ± 27 ms，P = 0.0003。在 37 例患者中的 36 例中，QuickOpt 算法推荐左心室预激，VVD 为 42 ± 18 ms（中位数 40 ms；四分位距 30-55 ms，P <0.00001）。使用 QuickOpt 基于 VVD 的双心室起搏的 QRSd 明显长于同步双心室起搏（168 ± 25 ms 比 156 ± 20 ms；差异 12 ± 11 ms；P <0.00001）。这种延长与绝对 VVD 值相关（R = 0.66，P <0.00001）。
QuickOpt 算法系统地偏向左前激 VVD，这导致与同步双心室起搏相比 QRSd 显著延长。没有理由认为系统地加宽 QRSd 的操作应被认为是优化生理的。在进行大型临床研究之前，基于设备的 CRT 优化算法应在各种情况下进行系统的机制临床前评估。
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