Influence of Atrioventricular Optimization on Hemodynamic Parameters and Quality of Life in Patients with Dual Chamber Pacemaker with Ventricular Lead in Right Ventricular Outflow Tract.

Annals of noninvasive electrocardiology : the official journal of the International Society for Holter and Noninvasive Electrocardiology, Inc

PubMedID: 24597906

Klimczak A, Budzikowski AS, Rosiak M, Zielinska M, Urbanek B, Bartczak K, Chudzik M, Wranicz JK. Influence of Atrioventricular Optimization on Hemodynamic Parameters and Quality of Life in Patients with Dual Chamber Pacemaker with Ventricular Lead in Right Ventricular Outflow Tract. Ann Noninvasive Electrocardiol. 2014;.
BACKGROUND
The aim of this study was to ascertain whether individual atrioventricular delay (AVD) optimization using impedance cardiography (ICG) offers beneficial hemodynamic effects as well as improved exercise tolerance and quality of life in patients with requiring constant right ventricular pacing.

METHODS
There were 37 patients with advanced AV block included in the study. Several examinations were performed at the beginning. Next, the optimization of AVD by ICG was done. The next step of the study patients have been randomized into optimal AVD group (AVDopt) or factory setting group (AVDfab). After 3 months, the follow-up all data were collected again and crossover was performed. After another 3 months, during the final follow-up all these measures were repeated.

RESULTS
In 87.5% patients, AVDopt were different than factory value. Cardiac output (CO), cardiac index (CI), and stroke volume (SV) were significantly (P < 0.001) higher in AVDopt group than in AVDfab group (CO: 6.0 ± 1.4 L/minute vs. 5.3 ± 1.2 L/minute; SV: 85.8 ± 25.7 mL vs.76.9 ± 22.5 mL; CI: 3.2 ± 0.7 L/minute/m(2) vs. 2.7 ± 0.6 L/minute/m(2) ). There was a statistical significant (P < 0.05) reduction of proBNP and NYHA class in patients with AVDopt compared to AVDfab (proBNP: 196.4 ± 144.7pg/mL vs. 269.4 ± 235.8 pg/mL; NYHA class: 1.7 ± 0.5 vs. 2.3 ± 0.6). Six-minute walking test was significantly (P < 0.05) higher in AVDopt group (409 ± 90 m) than in AVDfab group (362 ± 93 m). There were no statistically significant differences in echocardiographic parameters between AVDopt and AVDfab settings.

CONCLUSION
Our study results suggest that AVD optimization in patients with DDD pacemaker with ICG improves hemodynamic when compared to the default factory settings. Furthermore, optimally programmed AVD reduces BNP and improves exercise tolerance and functional class.