Primjena intrakardijalnih elektrograma u optimizaciji resinkronizacijskoga elektrostimulatora srca

Pezo Nikolić, Borka (2017) Primjena intrakardijalnih elektrograma u optimizaciji resinkronizacijskoga elektrostimulatora srca. PhD thesis, Sveučilište u Zagrebu.

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Abstract

Intracardiac delay optimization of biventricular pacing devices currently relies on timeconsuming echocardiographic measurements. Automatic intracardiac electrogram (IEGM) method for atrioventricular (AV) and interventricular (VV) delay optimization was developed by St. Jude, which can be performed during routine device follow-up. Some manufacturers do not provide automated intracardiac electrogram (IEGM) systems for AV and VVdelay optimization in cardiac resynchronization therapy (CRT). We aimed to evaluate the diagnostic accuracy of manual IEGM method in patients undergoing CRT. We included 48 patients previously implanted with Medtronic Syncra, cardiac resynchronization therapy devices. One month after CRT implantation all patients underwent standard device interrogation followed by optimization of the CRT pacemaker settings by IEGM method and by echocardiography. Patients had a mean age of 60,7 ± 11,8 years and 33 (68,8%) were males. After the CRT implantation, ejection fraction of the left ventricle increased from 28,0 ± 7,9 % to 39,1 ± 11,0 % (P<0.001). Optimal aortic velocity time integral (AVTI) was obtained when VV was set to 20 – 50 ms left ventricular pre-activation. There was a strong correlation between VV values determined by echocardiography and IEGM (ρ = 0.823, P<0.001). We found no significant difference in sensed atrioventricular interval, paced atrioventricular interval, LVOT VTI and VV values between echocardiography and IEGM method. However, IEGM was significantly less time consuming than echocardiography [20 (10 – 28) vs. 40 (35 – 60) minutes, P<0.001]. The automated programmer-based IEGM method provides a reliable and simpler alternative to standard techniques for CRT optimization. Our study indicates that manual IEGM method may be good alternative to echocardiography and automated IEGM method. It also emphasizes the need for implementation of automated IEGM systems by all CRT device manufacturers.

Abstract in Croatian

Optimizacija intrakardijalnih intervala stimulacije u resinkronizacijskim elektrostimulatorima ovisi trenutno o vremenski dugotrajnoj ultrazvučnoj metodi. Metoda automatskih intrakardijalnih elektrograma (IEGM) za optimizaciju atrioventrikulskog i intereventrikulskog intervala razvijena od St. Jude može se koristiti za vrijeme rutinske kontrole. Neki proizvođači nemaju automatski IEGM sistem atrioventrikulske (AV) i interventrikulske (VV) optimizacije u srčanoj resinkronzacijskoj terapiji (CRT). Cilj ovog istraživanja bio je procijeniti dijagnostičku vrijednost ručne IEGM metode kod pacijenta s ugrađenim CRT-om. U naše istraživanje uključeno je 48 pacijenata kojima je prethodno ugrađen Medtronic Syncra CRT. Mjesec dana nakon ugradnje svi pacijenti su došli na standardnu kontrolu elektrostimulatora nakon čega je učinjena optimizacija CRT-a, prvo IEGM metodom a potom ultrazvučno. Prosječna dob pacijenta bila je 60,7 ± 11,8 godine od čega su 33 (68,8%) muškarci. Nakon ugradnje CRT ,ejekcijska frakcija lijeve klijetke narasla je s 28,0 ± 7,9 % na 39,1 ± 11,0 % (P<0.001). Najveći integral brzine protoka u izgonskom traktu lijeve klijetke (LVOT VTI) dobiven je pri VV intervalu od 20 – 50 ms lijeve preekscitacije. Postoji snažna korelacija između trajanja VV intervala dobivenog ultrazvučno i IEGM (ρ = 0.823, P<0.001). Nismo našli statistički značajnu razliku AV ,VV LVOT VTI vrijednosti dobivenih ultrazvučno i IEGM metodom. Ipak, IEGM metoda zahtjeva bitno manje vremena od ultrazvučne metode [20 (10 – 28) vs. 40 (35 – 60) minuta, P<0.001].

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