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3D vectorcardiography confirms electrical synchronization achieved by dynamic programming of atrioventricular delay

Session Moderated ePosters 7: contemporary cardiac resynchronization therapy: is there room for improvement?

Speaker Frits Prinzen

Congress : EHRA 2019

  • Topic : arrhythmias and device therapy
  • Sub-topic : Cardiac Resynchronization Therapy
  • Session type : Moderated Posters
  • FP Number : 677

Authors : F W Prinzen (Maastricht,NL), EB Engels (Maastricht,NL), B Thibault (Montreal,CA), J Mangual (Minneapolis,US), N Badie (Minneapolis,US), L Mcspadden (Minneapolis,US), L Calo (Rome,IT), P Ritter (Bordeaux-Pessac,FR), C Pappone (San Donato Milanese,IT), K Bode (Leipzig,DE)

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Authors:
F W Prinzen1 , EB Engels1 , B Thibault2 , J Mangual3 , N Badie3 , L Mcspadden3 , L Calo4 , P Ritter5 , C Pappone6 , K Bode7 , 1Cardiovascular Research Institute - Maastricht - Netherlands , 2Montreal Heart Institute - Montreal - Canada , 3Abbott Northwestern Hospital, Abbott - Minneapolis - United States of America , 4Polyclinic Casilino of Rome - Rome - Italy , 5Hospital Haut Leveque - Bordeaux-Pessac - France , 6IRCCS, Policlinico San Donato - San Donato Milanese - Italy , 7Heart Center of Leipzig - Leipzig - Germany ,

Citation:

Background: SyncAV is a CRT algorithm that continually programs the atrioventricular (AV) delay (AVD) shorter than the intrinsic AV conduction time (by a programmable offset). This algorithm aims to improve electrical synchrony between intrinsic, left ventricle (LV)-paced, and right ventricle-paced activation wavefronts. ECG-based vectorcardiography (VCG) measurements combine QRS duration (QRSd) and the electrical force of ventricular activation to assess electrical synchrony. The 3D QRS area under the x/y/z deflection curves has specifically been linked to acute LV hemodynamic improvement and long-term CRT response.

Purpose: Assess QRS metrics derived from 3D VCG to evaluate the improvement in electrical synchrony provided by SyncAV during bi-ventricular (BiV) pacing in a large patient population.

Methods: Patients previously implanted with a CRT device underwent 12-lead surface ECG recordings. 3D VCG metrics were derived by a blinded observer from the ECG using the Kors matrix during the following settings: intrinsic ventricular activation, BiV nominal (140/110 ms sensed/paced AVD), and BiV + SyncAV Opt (patient-optimized offset resulting in the greatest QRS narrowing).

Results:  One hundred patients (71% male, 40% ischemic, 65% LBBB, ejection fraction 32±9%) completed VCG QRS assessment. The 12-lead ECG, x/y/z projected VCG, and vector magnitude (VM) for BiV nominal and BiV + SyncAV Opt are shown for a representative patient (left panels). As shown by the bar graphs (right panel), QRS duration was narrowed successively from (166±24 ms) during intrinsic conduction to 137±23ms during BiV nominal pacing, and (122±22ms, during BiV + SyncAV Opt. Likewise, 3D QRS amplitude during intrinsic activation (1.47±0.55mV) was reduced with BiV nominal pacing (1.14±0.49mV) and tended towards a further decrease with BiV+SyncAV Opt (1.09±0.48mV). 3D QRS area during intrinsic activation (90±42 mV.ms) also decreased with BiV nominal pacing (65±39 mV.ms), with further reduction achieved by BiV + SyncAV Opt (53±30 mV.ms).

Conclusion: VCG measurements support the evidence that BiV pacing with an optimized SyncAV offset improves electrical synchrony beyond conventional CRT with nominal settings. Additional, larger studies are needed to further evaluate the relationship between the electrical synchrony achieved with SyncAV and long-term patient outcome.

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