Biventricular pacing set-up optimization to maximize cardiac resynchronization benefit – current options

Czech version

Authors: D. Marek
Authors‘ workplace: I. interní klinika – kardiologická FN Olomouc
Published in: Kardiol Rev Int Med 2014, 16(2): 95-101
Category: Cardiology Review

Overview

Cardiac resynchronization therapy (CRT) improves the quality of life and/ or haemodynamic parameters only in 2/ 3 of heart failure patients with a biventricular pacemaker implanted. In the rest of these patients (non‑responders), further refinement of pacing parameters is provided. This atrioventricular delay (AVD) and ventriculoventricular delay (VVD) optimization may help to improve cardiac performance in some of them. Echocardiography is widely used to assess the effect of AVD and VVD programming. The diastolic filling pattern, the length of the diastole, stroke volume/ cardiac output, ejection fraction, LV dP/ dT and LV contraction synchrony by tissue Doppler or speckle tracking are the most frequent criteria used for optimization. Whilst all these variables are proved to demonstrate an instant effect of AVD/ VVD optimization in selected groups of CRT patients, neither a randomized study nor a meta‑analysis showed any long‑term benefit in the CRT population. This article describes the theoretical concept of optimization, certain methodological problems and unresolved issues in CRT optimization and evidence in literature already published. Optimization options are summarized in current guidelines but an individual approach is recommended in non‑responders.

Keywords:
cardiac resynchronization therapy – atrioventricular delay – ventriculoventricular delay – echocardiography – optimization

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