Left univentricular pacing for cardiac resynchronization therapy using rate-adaptive atrioventricular delay

Li-Jin Pu; Yu Wang; Lu-Lu Zhao; Tao Guo; Shu-Min Li; Bao-Tong Hua; Ping Yang; Jun Yang; Yan-Zhou Lu; Liu-Qing Yang; Ling Zhao; Hai-Yun Luo

doi:10.11909/j.issn.1671-5411.2017.02.006

Left univentricular pacing for cardiac resynchronization therapy using rate-adaptive atrioventricular delay

J Geriatr Cardiol. 2017 Feb;14(2):118-126. doi: 10.11909/j.issn.1671-5411.2017.02.006.

Authors

Li-Jin Pu^{1

2}, Yu Wang^{1

2}, Lu-Lu Zhao², Tao Guo^{1

2}, Shu-Min Li¹, Bao-Tong Hua¹, Ping Yang¹, Jun Yang¹, Yan-Zhou Lu², Liu-Qing Yang³, Ling Zhao^{1

2}, Hai-Yun Luo⁴

Affiliations

¹ Department of Cardiology, the First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China.
² Institute of Cardiovascular Diseases of Yunnan Province, Kunming, Yunnan, China.
³ Cardiovascular Division and Lillehei Heart Institute, University of Minnesota, Minnesota, USA.
⁴ Department of Pharmacology, College of Basic Medicine, Kunming Medical University, Kunming, Yunnan, China.

PMID: 28491086
PMCID: PMC5409353
DOI: 10.11909/j.issn.1671-5411.2017.02.006

Abstract

Objective: To evaluate left univentricular (LUV) pacing for cardiac resynchronization therapy (CRT) using a rate-adaptive atrioventricular delay (RAAVD) algorithm to track physiological atrioventricular delay (AVD).

Methods: A total of 72 patients with congestive heart failure (CHF) were randomized to RAAVD LUV pacing versus standard biventricular (BiV) pacing in a 1: 1 ratio. Echocardiography was used to optimize AVD for both groups. The effects of sequential BiV pacing and LUV pacing with optimized A-V (right atrio-LV) delay using an RAAVD algorithm were compared. The standard deviation (SD) of the S/R ratio in lead V1 at five heart rate (HR) segments (R_S/R-SD5), defined as the "tracking index," was used to evaluate the accuracy of the RAAVD algorithm for tracking physiological AVD.

Results: The QRS complex duration (132 ± 9.8 vs. 138 ± 10 ms, P < 0.05), the time required for optimization (21 ± 5 vs. 50 ± 8 min, P < 0.001), the mitral regurgitant area (1.9 ± 1.1 vs. 2.5 ± 1.3 cm², P < 0.05), the interventricular mechanical delay time (60.7 ± 13.3 ms vs. 68.3 ± 14.2 ms, P < 0.05), and the average annual cost (13,200 ± 1000 vs. 21,600 ± 2000 RMB, P < 0.001) in the RAAVD LUV pacing group were significantly less than those in the standard BiV pacing group. The aortic valve velocity-time integral in the RAAVD LUV pacing group was greater than that in the standard BiV pacing group (22.7 ± 2.2 vs. 21.4 ± 2.1 cm, P < 0.05). The R_S/R-SD5 was 4.08 ± 1.91 in the RAAVD LUV pacing group, and was significantly negatively correlated with improved left ventricular ejection fraction (LVEF) (ΔLVEF, Pearson's r = -0.427, P = 0.009), and positively correlated with New York Heart Association class (Spearman's r = 0.348, P = 0.037).

Conclusions: RAAVD LUV pacing is as effective as standard BiV pacing, can be more physiological than standard BiV pacing, and can decrease the average annual cost of CRT.

Keywords: Cardiac resynchronization therapy; Congestive heart failure; Left univentricular pacing; Rate adaptive atrio-ventricular delay.