Post-CRT Imaging Based Optimization

Theodore P. Abraham, Veronica Lea J Dimaano, Aurélio C. Pinheiro

Research output: Chapter in Book/Report/Conference proceedingChapter

Abstract

The utility of CRT optimization remains to be confi ned to patients whose response to the treatment is either suboptimal or negligible. There are several techniques, mostly echocardiographic, to optimize device settings but none has been universally accepted as gold standard. Methods differ in recording techniques and may therefore vary signifi cantly in performance. Several studies have employed various techniques in interrogating AV interval with or without concomitant V-V interval optimization. Optimization was performed at varying time points. Even the defi nition for favorable response to CRT varied. Optimization of AV and V-V intervals is patient-specifi c and optimal values change over time. This may relate to time-related LV reverse remodeling or to progression of disease. The effects of inter-atrial conduction defect, right atrial pacing, and exercise on AV delay add complexities to performance of AV delay optimization. At the very least, it has to be ensured that the programmed AV delay should neither produce fusion of mitral E and A waves nor truncation of the latter. Despite evidences of hemodynamic benefi ts, the utility of V-V interval optimization remains controversial. Evidence for the incremental long-term benefi ts on mortality and morbidity is still lacking. Three large clinical trials reported confl icting results in terms of clinical and echocardiographic improvement. Differences in the study designs could have contributed to the confl icting results. It is important to remember, however, that simultaneous biventricular pacing is not always synonymous with suboptimal V-V interval, nor should sequential pacing be routinely regarded as ideal.

Original languageEnglish (US)
Title of host publicationCardiac Imaging in Electrophysiology
PublisherSpringer-Verlag London Ltd
Pages263-276
Number of pages14
ISBN (Electronic)9781848824867
ISBN (Print)9781848824850
DOIs
StatePublished - Jan 1 2012

Keywords

  • AV delay optimization
  • Cardiac resynchronization therapy
  • CRT optimization
  • Echocardiography
  • Imaging post CRT

ASJC Scopus subject areas

  • Medicine(all)

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    Abraham, T. P., Dimaano, V. L. J., & Pinheiro, A. C. (2012). Post-CRT Imaging Based Optimization. In Cardiac Imaging in Electrophysiology (pp. 263-276). Springer-Verlag London Ltd. https://doi.org/10.1007/978-1-84882-486-7_17