Author + information
- Osman Ziya Arık1,
- Gülhan Yüksel Kalkan2,
- Durmuş Yıldıray Şahin2,
- Zafer Elbasan2,
- Mustafa Gür2,
- Osman Kuloğlu2,
- Kamuran Tekin3,
- Murat Gençaslan4,
- Caner Türkoğlu2,
- Haci Ali Uçak2 and
- Murat Çaylı2
Optimization of atrioventricular (AV) delay time has positive effects on left ventricular functions in patients with DDD pacemaker. Although echocardiographic methods are still the most commonly used ones for the optimization of AV delay time, the gold standard method used for optimization is still debated. Automated functional imaging (AFI) is a strain calculation method, that is based on speckle tracking technique and it makes strain calculation faster and easier. In our study, we aimed to evaluate the effect of different AV delay times on left ventricle (LV) systolic and diastolic functions by using brain natriuretic peptide (BNP) levels, pulse wave Doppler (PWD) echocardiography and AFI in patients with DDD pacemaker and preserved LV systolic function.
The study population consisted of 40 patients with DDD pacemaker implanted for third degree AV block and preserved left ventricular systolic function (19 men and 21 women; mean age 64,3±10,9 years). Patients with implantable cardioverter defibrillator (ICD), biventricular pacemaker, LV systolic dysfunction (ejection fraction <%50), other moderate or severe organ failure (e.g. chronic liver disease, renal insufficiency), known or suspected coronary artery disease, moderate or severe valvular heart disease, atrial fibrillation or atrial flutter, anemia and suboptimal echocardiographic images were excluded from the study. During each pacing period, blood samples were taken for measurement of brain natriuretic peptide (BNP) levels, telemetric and echocardiographic evaluations were performed to all patients. Also peak systolic global longitudinal strain (PSGLS) was calculated by using AFI method.
The baseline clinical and echocardiographic data of the patients are presented in Table 1. No significant differences except for left ventricular outflow tract-velocity time integral (LVOT-VTI) were observed in pulse wave Doppler parameters with different AV delay times. LVOT-VTI values, PSGLS and BNP levels were better with 150 and 200 ms AV delay times when compared to 100 ms (for 100-150 ms: 0,017, and for 100-200 ms p:0,013; for 100-150 ms and for 100-200 ms p<0,001; for 100-150 ms p:0,001, and for 100-200 ms p:<0,001 respectively) (Table 2 and 3).
Our results showed that there were no significant changes on LV diastolic functions by the setting AV delay. In addition, when AV delay prolonged in physiological limits, BNP level was decreased and PSGLS and LVOT-VTI values were increased.
In patients with implanted DDD pacemaker and preserved left ventricular systolic function, increasing AV delay time has beneficial effects on left ventricular systolic performance in acute phase, without deteriorating diastolic function, as shown by AFI method in our study.
|Age (mean ± SD), years||64,3±10,9|
|Male, (%)||19 (47,5)|
|Female, (%)||21 (52,5)|
|Hypertension, (%)||25 (62,5)|
|Diabetes mellitus, (%)||12 (30)|
|Hyperlipidemia, (%)||8 (20)|
|Cigarette, (%)||2 (5)|
|Pacing period, months||18,8±11,5|
|Left ventricular EF, %||61,5±6,0|
|Left atrium, mm||35,3±3,1|
|Interventricular septum, mm||10,1±2,3|
|Posterior wall, mm||9,4±2,2|
SD= standard deviation, EF= ejection fraction, LVEDd= left ventricule end-diastolic diameter, LVESd= left ventricule end-systolic diameter
|100 ms||150 ms||200 ms||p overall|
|E, m/sn||0,51 (0,3-0,8)||0,58 (0,3-0,9)||0,54 (0,3-0,8)||0,72|
|A, m/sn||0,82 (0,4-1,3)||0,84 (0,5-1,3)||0,84 (0,4-1,3)||0,27|
|E/A||0,67 (0,43-1,5)||0,67 (0,5-1,29)||0,67 (0,45-1,5)||0,43|
AV=atrioventricular, E= early diastolic peak flow velocity, A= late diastolic peak flow velocity, E/A= the ratio of early and late diastolic peak flow velocity, IVRT=isovolumetric relaxation time
|100 ms||150 ms||200 ms||p|
BNP= brain natriuretic peptide, PSGLS= peak systolic global longitudinal strain, LVOT-VTI= left ventricule outflow tract-velocity time index, AV= atrioventricular