Cardiovascular Implantable Electronic Devices -> Bradycardia Devices: -> Clinical Trials D-PO02 - Poster Session II (ID 47) Poster

D-PO02-086 - Effect Of Atrioventricular Optimization On Left Ventricular Function With Dual Chamber Pacemaker; Prospective Randomized Trial (ID 1007)

Abstract

Background: It is known that continuous right ventricular pacing in patients with permanent pacemaker causes left ventricular dysfunction in the long term. The optimal AV delay should be provided for the longest diastolic filling and maximal cardiac output.
Objective: This study aims to evaluate the effect of optimizing AV delay on left ventricular function
Methods: From September 2015 to August 2017, the patients were prospectively enrolled that had been scheduled to implant DDD pacemaker. They were randomly assigned to a group of fixed AV delays already set by the company and an optimized group of AV delays that could maximize stroke volume measured by Doppler echocardiography. Then they were divided into a group with pacing AV delay less than 200 msec and a group with 200 msec or longer. They were compared for changes in BNP and echocardiographic parameters such as LVEF, CO, LVEDV, and LVESV.
Results: A total of 80 patients (mean age 73.3±9.8 years, 36(45%) male) were included in this study. Ventricular pacing rate was 96.0 % in both groups. After 1 year, the changes of BNP, EF, CO, LVEDV and LVESV did not differ between the optimization group and the factory setting group. In the group with an AV delay of 200 msec or longer, EF increases were higher (2.77 % versus 0.65 %, p value=0.043) and LVESV changes were better (-0.76 ml versus +3.19ml, p value=0.026).
Conclusion: Echocardiographically optimized AV delay did not improve LV function during the one year follow up period. Rather longer AV delay (more than 200msec) improved LVEF and LVESV.
Outcomes by AV delay optimization and AV delay length
1year follow upAV delay optimization(n=40)AV dekat factory setting(n=40)P valueAV delay less than 200ms(n=40)AV delay more than 200ms(n=25)P value
EF change (%)+2.5±4.6+1.2±3.00.205+0.65±3.0+2.77±3.00.043
cardiac output change (L/min)-0.07±0.7+0.08±0.80.480-0.059±0.64+0.281±0.10.711
BNP change(pg/lm)-534±14- 35±320.773-35.5±32+50±450.053
LVEDV change (ml)+2.768±14.2+ 067±14.40.161+8.32±14.2+1.93±14.40.129
LVESV chanbe (ml)-0.091±6.1+ 2.642±6.30.098+3.19±6.3-0.76±5.60.026

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