Inadvertent QRS prolongation by an optimization device-based algorithm in patients with cardiac resynchronization therapy

Kód výsledku v IS VaVaI

<a href="https://www.isvavai.cz/riv?ss=detail&h=RIV%2F00023001%3A_____%2F22%3A00083687" target="_blank" >RIV/00023001:_____/22:00083687 - isvavai.cz</a>

Nalezeny alternativní kódy

RIV/00216208:11110/22:10448812 RIV/00216208:11150/22:10448812 RIV/00179906:_____/22:10448812

Výsledek na webu

<a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0275276" target="_blank" >https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0275276</a>

DOI - Digital Object Identifier

<a href="http://dx.doi.org/10.1371/journal.pone.0275276" target="_blank" >10.1371/journal.pone.0275276</a>

Jazyk výsledku

angličtina

Název v původním jazyce

Inadvertent QRS prolongation by an optimization device-based algorithm in patients with cardiac resynchronization therapy

Popis výsledku v původním jazyce

Background Device-based algorithms offer the potential for automated optimization of cardiac resynchronization therapy (CRT), but the process for accepting them into clinical use is currently still ad-hoc, rather than based on pre-clinical and clinical testing of specific features of validity. We investigated how the QuickOpt-guided VV delay (VVD) programming performs against the clinical and engineering heuristic of QRS complex shortening by CRT. Methods A prospective, 2-center study enrolled 37 consecutive patients with CRT. QRS complex duration (QRSd) was assessed during intrinsic atrioventricular conduction, synchronous biventricular pacing, and biventricular pacing with QuickOpt-proposed VVD. The measurements were done manually by electronic calipers in signal-averaged and magnified 12-lead QRS complexes. Results Native QRSd was 174 +/- 22 ms. Biventricular pacing with empiric AVD and synchronous VVD resulted in QRSd 156 +/- 20 ms, a significant narrowing from the baseline QRSd by 17 +/- 27 ms, P = 0.0003. In 36 of 37 patients, the QuickOpt algorithm recommended left ventricular preexcitation with VVD of 42 +/- 18 ms (median 40 ms; interquartile range 30-55 ms, P &lt; 0.00001). QRSd in biventricular pacing with QuickOpt-based VVD was significantly longer compared with synchronous biventricular pacing (168 +/- 25 ms vs. 156 +/- 20 ms; difference 12 +/- 11ms; P &lt; 0.00001). This prolongation correlated with the absolute VVD value (R = 0.66, P &lt; 0.00001). Conclusions QuickOpt algorithm systematically favours a left-preexcitation VVD which translates into a significant prolongation of the QRSd compared to synchronous biventricular pacing. There is no reason to believe that a manipulation that systematically widens QRSd should be considered to optimize physiology. Device-based CRT optimization algorithms should undergo systematic mechanistic pre-clinical evaluation in various scenarios before they are tested in large clinical studies.

Název v anglickém jazyce

Inadvertent QRS prolongation by an optimization device-based algorithm in patients with cardiac resynchronization therapy

Popis výsledku anglicky

Background Device-based algorithms offer the potential for automated optimization of cardiac resynchronization therapy (CRT), but the process for accepting them into clinical use is currently still ad-hoc, rather than based on pre-clinical and clinical testing of specific features of validity. We investigated how the QuickOpt-guided VV delay (VVD) programming performs against the clinical and engineering heuristic of QRS complex shortening by CRT. Methods A prospective, 2-center study enrolled 37 consecutive patients with CRT. QRS complex duration (QRSd) was assessed during intrinsic atrioventricular conduction, synchronous biventricular pacing, and biventricular pacing with QuickOpt-proposed VVD. The measurements were done manually by electronic calipers in signal-averaged and magnified 12-lead QRS complexes. Results Native QRSd was 174 +/- 22 ms. Biventricular pacing with empiric AVD and synchronous VVD resulted in QRSd 156 +/- 20 ms, a significant narrowing from the baseline QRSd by 17 +/- 27 ms, P = 0.0003. In 36 of 37 patients, the QuickOpt algorithm recommended left ventricular preexcitation with VVD of 42 +/- 18 ms (median 40 ms; interquartile range 30-55 ms, P &lt; 0.00001). QRSd in biventricular pacing with QuickOpt-based VVD was significantly longer compared with synchronous biventricular pacing (168 +/- 25 ms vs. 156 +/- 20 ms; difference 12 +/- 11ms; P &lt; 0.00001). This prolongation correlated with the absolute VVD value (R = 0.66, P &lt; 0.00001). Conclusions QuickOpt algorithm systematically favours a left-preexcitation VVD which translates into a significant prolongation of the QRSd compared to synchronous biventricular pacing. There is no reason to believe that a manipulation that systematically widens QRSd should be considered to optimize physiology. Device-based CRT optimization algorithms should undergo systematic mechanistic pre-clinical evaluation in various scenarios before they are tested in large clinical studies.

Druh

J_imp - Článek v periodiku v databázi Web of Science

CEP obor

—

OECD FORD obor

30201 - Cardiac and Cardiovascular systems

Projekt

—

Návaznosti

I - Institucionalni podpora na dlouhodoby koncepcni rozvoj vyzkumne organizace

Rok uplatnění

2022

Kód důvěrnosti údajů

S - Úplné a pravdivé údaje o projektu nepodléhají ochraně podle zvláštních právních předpisů

Název periodika

PLoS ONE [online]

ISSN

1932-6203

e-ISSN

1932-6203

Svazek periodika

17

Číslo periodika v rámci svazku

9

Stát vydavatele periodika

US - Spojené státy americké

Počet stran výsledku

12

Strana od-do

"art. no. e0275276"

Kód UT WoS článku

000922920400001

EID výsledku v databázi Scopus

2-s2.0-85138626724