Prospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Nov 26, 2015; 7(11): 801-807
Published online Nov 26, 2015. doi: 10.4330/wjc.v7.i11.801
Comparison of echocardiography and device based algorithm for atrio-ventricular delay optimization in heart block patients
Rajesh Vijayvergiya, Ankur Gupta
Rajesh Vijayvergiya, Ankur Gupta, Department of Cardiology, Advanced Cardiac Centre, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
Author contributions: All authors were actively involved in management of the index case.
Institutional review board statement: The study was reviewed and approved by the Institutional Review Board and Ethics Committee of Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India.
Clinical trial registration statement: The trial was not registered at Clinical Trial Registry-India or any other registry site. For the information please.
Informed consent statement: A written informed consent was taken from all patients for enrolment in the study.
Conflict-of-interest statement: There is no conflict of interest to be declared by both the authors of the manuscript. There is no funding received for the particular study. Authors do not have any financial or intellectual association with any firm/agency which can directly or indirectly affect the results of the study.
Data sharing statement: There is no additional data available related to this study. Hence, there is no possibility of data sharing with any other manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Rajesh Vijayvergiya, MD, DM, FSCAI, FISES, FACC, Professor, Department of Cardiology, Advanced Cardiac Centre, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh 160012, India. rajeshvijay999@hotmail.com
Telephone: +91-172-2756512 Fax: +91-172-2744401
Received: February 8, 2015
Peer-review started: February 9, 2015
First decision: June 4, 2015
Revised: September 9, 2015
Accepted: October 12, 2015
Article in press: October 13, 2015
Published online: November 26, 2015
Processing time: 294 Days and 11.5 Hours
Abstract

AIM: To compare the atrio-ventricular (AV/PV) delay optimization by echocardiography and intra-cardiac electrocardiogram (IEGM) based QuickOpt algorithm in complete heart block (CHB) patients, implanted with a dual chamber pacemaker.

METHODS: We prospectively enrolled 20 patients (age 59.45 ± 18.1 years; male: 65%) with CHB, who were implanted with a dual chamber pacemaker. The left ventricular outflow tract velocity time-integral was measured after AV/PV delay optimization by both echocardiography and QuickOpt algorithm method. Bland-Altman analysis was used for agreement between the two techniques.

RESULTS: The optimal AV and PV delay determined by echocardiography was 155.5 ± 14.68 ms and 122.5 ± 17.73 ms (P < 0.0001), respectively and by QuickOpt method was 167.5 ± 16.73 and 117.5 ms ± 9.10 ms (P < 0.0001), respectively. A good agreement was observed between optimal AV and PV delay as measured by two methods. However, the correlation of the optimal AV (r = 0.0689, P = 0.77) and PV (r = 0.2689, P = 0.25) intervals measured by the two techniques was poor. The time required for AV/PV optimization was 45.26 ± 1.73 min by echocardiography and 0.44 ± 0.08 min by QuickOpt method (P < 0.0001).

CONCLUSION: The programmer based IEGM method is an automated, quick, easier and reliable alternative to echocardiography for the optimization of AV/PV delay in CHB patients, implanted with a dual chamber pacemaker.

Keywords: Atrio-ventricular delay optimization; Complete heart block; Doppler echocardiography; Dual chamber pacemaker; Hemodynamics; QuickOpt algorithm

Core tip: Optimization of sensed and paced atrio-ventricular (AV/PV) delay is required for better hemodynamics in patients with complete heart block (CHB). Aim of the present study was to compare the AV/PV delay optimization by echocardiography and intra-cardiac electrocardiogram (IEGM) based QuickOpt algorithm in patients with CHB. We prospectively enrolled 20 patients of CHB who were implanted with a dual chamber pacemaker. A velocity time-integral of left ventricular outflow tract was measured following AV/PV delay optimization by both echocardiography and QuickOpt algorithm method. An agreement between the two techniques was assessed by Bland-Altman analysis. Optimal AV and PV delay as assessed by echocardiography was 155.5 ± 14.68 ms and 122.5 ± 17.73 ms (P < 0.0001), respectively and by QuickOpt method was 167.5 ± 16.73 ms and 117.5 ± 9.10 ms (P < 0.0001), respectively. The time required for AV/PV optimization was 45.26 ± 1.73 min by echocardiography and 0.44 ± 0.08 min by QuickOpt method (P < 0.0001). In conclusion, automated programmer based IEGM method is a quick, easy and reliable alternative to echocardiography for optimization of AV/PV delay in CHB patients.