Distinct impacts of heart rate and right atrial-pacing on left atrial mechanical activation and optimal AV delay in CRT.

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  • معلومة اضافية
    • Author-Supplied Keywords:
      atrioventricular delay
      cardiac resynchronization therapy
      electrophysiology-clinical
      heart failure
      optimization
    • Abstract:
      Background: Controversy exists regarding how atrial activation mode and heart rate affect optimal atrioventricular (AV) delay in cardiac resynchronization therapy. We studied these questions using high-reproducibility hemodynamic and echocardiographic measurements.Methods: Twenty patients were hemodynamically optimized using noninvasive beat-to-beat blood pressure at rest (62 ± 11 beats/min), during exercise (80 ± 6 beats/min), and at three atriallypaced rates: 5, 25, and 45 beats/min above rest, denoted as A paced,r + 5, A paced, r + 25, and A paced,r + 45, respectively. Left atrial myocardial motion and transmitral flow were timed echocardiographically.Results: During atrial sensing, raising heart rate shortened optimal AV delay by 25 ± 6ms (P < 0.001). During atrial pacing, raising heart rate from A paced,r+5 to A paced,r+25 shortened it by 16±6 ms; A paced,r+45 shortened it 17 ± 6 ms further (P<0.001).In comparison to atrial-sensed activation, atrial pacing lengthened optimal AV delay by 76±6 ms (P<0.0001) at rest, and at ~20 beats/min faster, by 85±7 ms(P<0.0001), 9±4 ms more (P = 0.017). Mechanically, atrial pacing delayed left atrial contraction by 63±5 ms at rest and by 73±5 ms (i.e.,by 10±5 ms more, P<0.05) at ~20 beats/min faster.Raising atrial rate by exercise advanced left atrial contraction by 7±2 ms (P=0.001). Raising it by atrial pacing did not (P=0.2).Conclusions: Hemodynamic optimal AV delay shortens with elevation of heart rate. It lengthens on switching from atrial-sensed to atrial-paced at the same rate, and echocardiography shows this sensed-paced difference in optima results from a sensed-paced difference in atrial electromechanical delay. The reason for the widening of the sensed-paced difference in AV optimum may be physiological stimuli (e.g.,adrenergic drive) advancing left atrial contraction during exercise but not with fast atrial pacing. [ABSTRACT FROM AUTHOR]
    • Abstract:
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    • Author Affiliations:
      1Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
      2International Centre for Circulatory Health, Nationa Heart and Lung Institute, Imperial College London, London, W12 0HS, UK
    • ISSN:
      0147-8389
    • Accession Number:
      10.1111/pace.13401
    • Accession Number:
      131163509
  • Citations
    • ABNT:
      KYRIACOU, A. et al. Distinct impacts of heart rate and right atrial-pacing on left atrial mechanical activation and optimal AV delay in CRT. Pacing & Clinical Electrophysiology, [s. l.], v. 41, n. 8, p. 959–966, 2018. DOI 10.1111/pace.13401. Disponível em: http://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=asn&AN=131163509&custid=s8280428. Acesso em: 28 jan. 2020.
    • AMA:
      Kyriacou A, Rajkumar CA, Pabari PA, et al. Distinct impacts of heart rate and right atrial-pacing on left atrial mechanical activation and optimal AV delay in CRT. Pacing & Clinical Electrophysiology. 2018;41(8):959-966. doi:10.1111/pace.13401.
    • APA:
      Kyriacou, A., Rajkumar, C. A., Pabari, P. A., Afzal Sohaib, S. M., Willson, K., Peters, N. S., … Francis, D. P. (2018). Distinct impacts of heart rate and right atrial-pacing on left atrial mechanical activation and optimal AV delay in CRT. Pacing & Clinical Electrophysiology, 41(8), 959–966. https://doi.org/10.1111/pace.13401
    • Chicago/Turabian: Author-Date:
      Kyriacou, Andreas, Christopher A. Rajkumar, Punam A. Pabari, S. M. Afzal Sohaib, Keith Willson, Nicholas S. Peters, Phang B. Lim, et al. 2018. “Distinct Impacts of Heart Rate and Right Atrial-Pacing on Left Atrial Mechanical Activation and Optimal AV Delay in CRT.” Pacing & Clinical Electrophysiology 41 (8): 959–66. doi:10.1111/pace.13401.
    • Harvard:
      Kyriacou, A. et al. (2018) ‘Distinct impacts of heart rate and right atrial-pacing on left atrial mechanical activation and optimal AV delay in CRT’, Pacing & Clinical Electrophysiology, 41(8), pp. 959–966. doi: 10.1111/pace.13401.
    • Harvard: Australian:
      Kyriacou, A, Rajkumar, CA, Pabari, PA, Afzal Sohaib, SM, Willson, K, Peters, NS, B. Lim, P, Kanagaratnam, P, Hughes, AD, Mayet, J, Whinnett, ZI & Francis, DP 2018, ‘Distinct impacts of heart rate and right atrial-pacing on left atrial mechanical activation and optimal AV delay in CRT’, Pacing & Clinical Electrophysiology, vol. 41, no. 8, pp. 959–966, viewed 28 January 2020, .
    • MLA:
      Kyriacou, Andreas, et al. “Distinct Impacts of Heart Rate and Right Atrial-Pacing on Left Atrial Mechanical Activation and Optimal AV Delay in CRT.” Pacing & Clinical Electrophysiology, vol. 41, no. 8, Aug. 2018, pp. 959–966. EBSCOhost, doi:10.1111/pace.13401.
    • Chicago/Turabian: Humanities:
      Kyriacou, Andreas, Christopher A. Rajkumar, Punam A. Pabari, S. M. Afzal Sohaib, Keith Willson, Nicholas S. Peters, Phang B. Lim, et al. “Distinct Impacts of Heart Rate and Right Atrial-Pacing on Left Atrial Mechanical Activation and Optimal AV Delay in CRT.” Pacing & Clinical Electrophysiology 41, no. 8 (August 2018): 959–66. doi:10.1111/pace.13401.
    • Vancouver/ICMJE:
      Kyriacou A, Rajkumar CA, Pabari PA, Afzal Sohaib SM, Willson K, Peters NS, et al. Distinct impacts of heart rate and right atrial-pacing on left atrial mechanical activation and optimal AV delay in CRT. Pacing & Clinical Electrophysiology [Internet]. 2018 Aug [cited 2020 Jan 28];41(8):959–66. Available from: http://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=asn&AN=131163509&custid=s8280428