Distinct impacts of heart rate and right atrial‐pacing on left atrial mechanical activation and optimal AV delay in CRT

Background Controversy exists regarding how atrial activation mode and heart rate affect optimal atrioventricular (AV) delay in cardiac resynchronization therapy. We studied these questions using high‐reproducibility hemodynamic and echocardiographic measurements. Methods Twenty patients were hemody...

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Published in:Pacing and clinical electrophysiology 2018-08, Vol.41 (8), p.959-966
Main Authors: Kyriacou, Andreas, Rajkumar, Christopher A., Pabari, Punam A., Sohaib, S.M. Afzal, Willson, Keith, Peters, Nicholas S., Lim, Phang B., Kanagaratnam, Prapa, Hughes, Alun D., Mayet, Jamil, Whinnett, Zachary I., Francis, Darrel P.
Format: Article
Language:English
Subjects:
atrioventricular delay
Blood pressure
cardiac resynchronization therapy
Contraction
Devices
Echocardiography
Electrocardiography
electrophysiology‐clinical
Heart failure
Heart rate
optimization
Physical training
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Summary:Background Controversy exists regarding how atrial activation mode and heart rate affect optimal atrioventricular (AV) delay in cardiac resynchronization therapy. We studied these questions using high‐reproducibility hemodynamic and echocardiographic measurements. Methods Twenty patients were hemodynamically optimized using noninvasive beat‐to‐beat blood pressure at rest (62 ± 11 beats/min), during exercise (80 ± 6 beats/min), and at three atrially paced rates: 5, 25, and 45 beats/min above rest, denoted as Apaced,r+5, Apaced,r+25, and Apaced,r+45, respectively. Left atrial myocardial motion and transmitral flow were timed echocardiographically. Results During atrial sensing, raising heart rate shortened optimal AV delay by 25 ± 6 ms (P 
ISSN:0147-8389
1540-8159
DOI:10.1111/pace.13401