Impact of synchronous atrioventricular delay optimization on left ventricle flow force angle evaluated by echocardiographic particle image velocimetry

Valter Bianchi; Alfonso R Martiniello; Jan Mangual; Vincenzo Tavoletta; Gianni Pedrizzetti; Giovanni Tonti; Valentina Maria Caso; Pio Caso; Antonio D'Onofrio

doi:10.1007/s10840-020-00923-7

Impact of synchronous atrioventricular delay optimization on left ventricle flow force angle evaluated by echocardiographic particle image velocimetry

J Interv Card Electrophysiol. 2022 Jan;63(1):1-8. doi: 10.1007/s10840-020-00923-7. Epub 2021 Jan 20.

Authors

Valter Bianchi¹, Alfonso R Martiniello², Jan Mangual³, Vincenzo Tavoletta², Gianni Pedrizzetti⁴, Giovanni Tonti⁵, Valentina Maria Caso², Pio Caso², Antonio D'Onofrio²

Affiliations

¹ Department of Cardiology, Monaldi Hospital, AORN Ospedali dei Colli, Napoli, Italy. valter.bianchi59@gmail.com.
² Department of Cardiology, Monaldi Hospital, AORN Ospedali dei Colli, Napoli, Italy.
³ Abbott, Sylmar, CA, USA.
⁴ Department of Engineering and Architecture, University of Trieste, Trieste, Italy.
⁵ Cardiology Division, "G. D'Annunzio" University, Chieti, Italy.

PMID: 33474704
DOI: 10.1007/s10840-020-00923-7

Abstract

Purpose: To evaluate the improvement in electrical synchrony and left ventricle (LV) hemodynamics provided by combining the dynamic atrioventricular delay (AVD) of SyncAV^TM CRT and the multiple LV pacing sites of MultiPoint pacing (MPP).

Methods: Patients with LBBB and QRS duration (QRSd) > 140 ms implanted with a CRT-D or CRT-P device and quadripolar LV lead were enrolled in this prospective study. During a post-implant follow-up visit, QRSd was measured from 12-lead surface electrograms by experts blinded to pacing configurations. QRSd reduction relative to intrinsic rhythm was evaluated during biventricular pacing (BiV) and MPP for two AVDs: nominal (140/110 ms paced/sensed) and SyncAV (patient-optimized SyncAV offset [10-60 ms] minimizing QRSd). Echocardiography particle imaging velocimetry (Echo-PIV) analysis was performed for each configuration. The resulting hemodynamic force LV flow angle (φ) was analyzed, which ranges from 0^o (predominantly base-apex forces) to 90^o (predominantly transverse forces). Higher angles indicate more energy dissipation at lateral walls due to transverse flow; lower angles indicate healthier flow aligned with the longitudinal base-apex path of the pressure gradient.

Results: Twelve patients (58% male, 17% ischemic, 32±7% ejection fraction, 165 ± 18 ms intrinsic QRSd) completed QRSd and Echo-PIV assessment. Relative to intrinsic rhythm, BiV and MPP with nominal AVD reduced QRSd by 10 ± 9% and 12 ± 9%, respectively. BiV+SyncAV and MPP+SyncAV further reduced QRSd by 19 ± 8%, (p < 0.05 vs. BiV with nominal AVD) and 23 ± 9% (p < 0.05 vs BiV+SyncAV), respectively. Echo-PIV showed similar sequential hemodynamic improvements. LV flow angular orientation during intrinsic activation (46 ± 3^o) reduced with BiV+SyncAV (37 ± 4^o, p < 0.05 vs intrinsic) and further with MPP+SyncAV (34 ± 4^o, p < 0.05 vs BiV+SyncAV).

Conclusion: These results suggest that SyncAV may improve electrical synchrony and influence LV flow patterns in patients suffering from heart failure compared to conventional CRT with a fixed AVD, with further improvement observed by combining with MPP.

Keywords: Cardiac resynchronization therapy; Echocardiography particle imaging velocimetry; Electrical optimization.

MeSH terms

Cardiac Resynchronization Therapy*
Echocardiography
Female
Heart Failure* / diagnostic imaging
Heart Failure* / therapy
Heart Ventricles / diagnostic imaging
Humans
Male
Prospective Studies
Rheology
Treatment Outcome
Ventricular Function, Left