التفاصيل البيبلوغرافية
| العنوان: |
A systematic approach to designing reliable VV optimization methodology: Assessment of internal validity of echocardiographic, electrocardiographic and haemodynamic optimization of cardiac resynchronization therapy. |
| المؤلفون: |
Kyriacou, Andreas1 andreas.kyriacou@imperial.ac.uk, Li Kam Wa, Matthew E.1, Pabari, Punam A.1, Unsworth, Beth1, Baruah, Resham1, Willson, Keith1, Peters, Nicholas S.1,2, Kanagaratnam, Prapa1,2, Hughes, Alun D.1,2, Mayet, Jamil1,2, Whinnett, Zachary I.1,2, Francis, Darrel P.1,2 |
| المصدر: |
International Journal of Cardiology. Aug2013, Vol. 167 Issue 3, p954-964. 11p. |
| مصطلحات موضوعية: |
*ATRIAL fibrillation treatment, *ECHOCARDIOGRAPHY, *HEMODYNAMICS, *SYSTEMATIC reviews, *CARDIAC pacemakers, *BIOLOGICAL rhythms |
| مستخلص: |
Abstract: Background: In atrial fibrillation (AF), VV optimization of biventricular pacemakers can be examined in isolation. We used this approach to evaluate internal validity of three VV optimization methods by three criteria. Methods and results: Twenty patients (16 men, age 75±7) in AF were optimized, at two paced heart rates, by LVOT VTI (flow), non-invasive arterial pressure, and ECG (minimizing QRS duration). Each optimization method was evaluated for: singularity (unique peak of function), reproducibility of optimum, and biological plausibility of the distribution of optima. The reproducibility (standard deviation of the difference, SDD) of the optimal VV delay was 10ms for pressure, versus 8ms (p= ns) for QRS and 34ms (p<0.01) for flow. Singularity of optimum was 85% for pressure, 63% for ECG and 45% for flow (Chi2 =10.9, p<0.005). The distribution of pressure optima was biologically plausible, with 80% LV pre-excited (p=0.007). The distributions of ECG (55% LV pre-excitation) and flow (45% LV pre-excitation) optima were no different to random (p= ns). The pressure-derived optimal VV delay is unaffected by the paced rate: SDD between slow and fast heart rate is 9ms, no different from the reproducibility SDD at both heart rates. Conclusions: Using non-invasive arterial pressure, VV delay optimization by parabolic fitting is achievable with good precision, satisfying all 3 criteria of internal validity. VV optimum is unaffected by heart rate. Neither QRS minimization nor LVOT VTI satisfy all validity criteria, and therefore seem weaker candidate modalities for VV optimization. AF, unlinking interventricular from atrioventricular delay, uniquely exposes resynchronization concepts to experimental scrutiny. [Copyright &y& Elsevier] |
| قاعدة البيانات: |
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