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A Prospective Randomized Evaluation of VV Delay Optimization in CRT‐D Recipients: Echocardiographic Observations from the RHYTHM II ICD Study
Author(s) -
BORIANI GIUSEPPE,
BIFFI MAURO,
MÜLLER CORD PAUL,
SEIDL KARLHEINZ,
GROVE RAINER,
VOGT JÜRGEN,
DANSCHEL WILFRIED,
SCHUCHERT ANDREAS,
DEHARO JEANCLAUDE,
BECKER THORSTEN,
BOULOGNE ERIC,
TRAPPE HANS JOACHIM
Publication year - 2009
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/j.1540-8159.2008.02267.x
Subject(s) - medicine , cardiac resynchronization therapy , cardiology , ejection fraction , ventricular outflow tract , hemodynamics , heart failure
Background: All current cardiac resynchronization therapy (CRT) devices allow the programming of the atrioventricular (AV/PV) delays and the sequential stimulation of the ventricles via the inter ventricular (VV) delay.Aim: This post hoc analysis of the RHYTHM II study was conducted to compare the reverse remodeling associated with VV delay optimization in patients randomly assigned to simultaneous (SIM) biventricular stimulation versus patients assigned to optimized VV delay programming (OPT) (1:3 randomization scheme).Methods: The analysis included 14 patients assigned to the SIM group and 34 patients to the OPT group who completed the 6‐month follow‐up period with paired echocardiographic recordings.Results: In both study groups, changes consistent with left ventricular (LV) remodeling were observed between baseline and 6 months, with significant improvements in LV function and decrease in LV dimensions. In the OPT group, there was also a decrease in left atrial diameter and mitral valve closure to opening time. At 6 months, the overall proportion of echocardiographic responders (≥10% decrease in LV end‐systolic volume or ≥5% absolute increase in LV ejection fraction) was similar in both groups. The optimal AV/VV delays, evaluated by maximization of LV outflow tract velocity time integral, changed over time.Conclusions: Ventriculo‐ventricular delay optimization was associated with better immediate hemodynamic function than simultaneous biventricular stimulation, though did not promote additional reverse remodeling at 6 months and did not increase the proportion of echocardiographic responders to CRT. Optimization of both the AV and VV intervals was patient‐specific and optimal values changed over time.