Automatic Optimization of Resting and Exercise Atrioventricular Interval Using a Peak Endocardial Acceleration Sensor: Validation with Doppler Echocardiography and Direct Cardiac Output Measurements

Peak endocardial acceleration (PEA) measured by an implantable acceleration sensor inside the tip of a pacing lead reflects ventricular filling and myocardial contractility. The contribution of the plateau phase of PEA as an indicator of optimal ventricular filling, hence of the appropriate atrioven...

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Bibliographic Details
Published in:Pacing and clinical electrophysiology 2000-11, Vol.23 (11P2), p.1762-1766
Main Authors: LEUNG, SUM-KIN, LAU, CHU-PAK, LAM, CATHY TSE-FUN, HO, SHERON, TSE, HUNG-FAT, YU, CHEUK-MAN, LEE, KATHY, TANG, MAN-OI, TO, KAM-MUI, RENESTO, FABRIZIO
Format: Article
Language:English
Subjects:
Aged
atrioventricular interval
Cardiac Output
Cardiac Pacing, Artificial - methods
Cardiac Pacing, Artificial - standards
Doppler echocardiography
Echocardiography, Doppler
Electrocardiography
Electrophysiologic Techniques, Cardiac - instrumentation
Exercise Test
Female
Heart Block - diagnostic imaging
Heart Block - physiopathology
Heart Block - therapy
Heart Rate
Humans
Male
Pacemaker, Artificial
peak endocardial acceleration
Reaction Time
Rest
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Summary:Peak endocardial acceleration (PEA) measured by an implantable acceleration sensor inside the tip of a pacing lead reflects ventricular filling and myocardial contractility. The contribution of the plateau phase of PEA as an indicator of optimal ventricular filling, hence of the appropriate atrioventricular interval (AVI) at rest and during exercise, was studied in 12 patients (age 69 ± 6 years) with complete AV block and a PEA sensing DDDR pacemakers (Living 1 Plus, Sorin Biomedica). At a mean resting heart rate of 79 ± 15 beats/min, the mean AVI optimized by PEA versus Doppler echocardiography (echo) were identical (142 ± 37 vs 146 ± 26 ms, P = 0.59). During submaximal exercise at a mean heart rate of 134 ± 6 beats/min, AVI optimized by PEA was 135 ± 37 ms. Cardiac output at rest, measured by the CO2 rebreathing method, was comparable with AVI determined by echo versus PEA (4.3 ± 2.9 and 3.7 ± 2.4 L/min, respectively), and increased to the same extent (8.0 ± 3.9 vs 8.3 ± 5.2 L/min) during sub‐maximal exercise. In patients with AV block, AVI automatically set by PEA was comparable with AVI manually optimized by Doppler echocardiography and was associated with comparable exercise induced hemodynamic changes.
ISSN:0147-8389
1540-8159
DOI:10.1111/j.1540-8159.2000.tb07014.x