Akute hämodynamische Auswirkung der Optimierung des AV-Intervalls mit der Impedanzkardiographie bei Zwei-Kammerstimulation

Akute hämodynamische Auswirkung der Optimierung des AV-Intervalls mit der Impedanzkardiographie bei Zweikammerstimulation Abstract: Hintergrund: Eine Optimierung des AV- Intervalls bei Zweikammerstimulation kann zu einer Verbesserung der Hämodynamik führen. Die Beurteilung der Hämodynamik ka...

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1. Verfasser: Daralammouri, Yunis
Beteiligte: Vogt, Sebastian (Prof. Dr.) (BetreuerIn (Doktorarbeit))
Format: Dissertation
Sprache:Deutsch
Veröffentlicht: Philipps-Universität Marburg 2011
Medizin
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contents Acute haemodynamic effects of optimizing the A-V interval with impedance cardiography in dual-chamber stimulation Background: Optimizing the A-V interval in dual-chamber stimulation may improve haemodynamics. Haemodynamic evaluation can be conducted by invasive or non-invasive procedures. One possible method is impedance cardiography, in which changes in cardiac volumes are recorded. The objective of this study was to analyze the acute haemodynamic effects of A-V intervals programmed at different lengths in dual-chamber stimulation, ascertained by determining stroke volume with impedance cardiography. Methods: The study was carried out with 42 patients who had a dual-chamber pacemaker or dual chamber ICD implanted, and the A-V interval was optimized by impedance cardiography. Left-ventricular pump function was determined by echocardiography, and the patients were divided into a group with maintained left-ventricular pump function (EF ≥50%) and another with limited (EF <50%). The criteria for inclusion were: 1. dual-chamber pacemaker or ICD; 2. sinus rhythm, and 3. consent. In all the patients the A-V intervals were programmed from 80-120 ms in steps of 20 ms or at the standard A-V interval (150 ms) and with their own conduction system (VVI 30/min.). For each A-V interval the mean stroke volume was determined in the steady state after 1 minute at the earliest. Results: The 42 patients in the study (33 men, 9 women; average age 66.8 ± 7.7 years, min. 47, max. 84 years) showed values of 45 ± 17 % for the mean ejection fraction (EF) during echocardiography. When the A-V interval was optimized, the stroke volume showed significantly higher values (74 ± 14 p <0001) than at the standard A-V interval (65± 13.5). The least-favourable A-V interval resulted in the significantly lowest stroke volume (least-favourable A-V interval 62.0 ±11.8 ms, optimum A-V interval 74 ± 14 p<0001). On average, the optimized A-V interval was significantly shorter than the least-favourable A-V interval (optimum A-V interval 103 ms ± 25, least-favourable A-V interval 129 ± 28 ms p<0001). In patients with an EF ≥ 50%, the optimized A-V interval was significantly shorter (96 +19.5) than in patients with an EF < 50% (109.5 ± 28 p= 0.048). Conclusions: It is possible to significantly improve the stroke volume acutely, at rest, by optimizing the A-V interval. There is no such thing as a universally optimum A-V interval; it is necessary to optimize it individually, the optimized A-V interval being in the shorter A-V conduction time range in both patients with an EF of ≥ 50% and those with an EF < 50%. Patients with limited LV pump function (EF < 50%) have significantly longer optimized A-V intervals than those whose LV function is not restricted.
spellingShingle Acute haemodynamic effects of optimizing the A-V interval with impedance cardiography in dual-chamber stimulation Background: Optimizing the A-V interval in dual-chamber stimulation may improve haemodynamics. Haemodynamic evaluation can be conducted by invasive or non-invasive procedures. One possible method is impedance cardiography, in which changes in cardiac volumes are recorded. The objective of this study was to analyze the acute haemodynamic effects of A-V intervals programmed at different lengths in dual-chamber stimulation, ascertained by determining stroke volume with impedance cardiography. Methods: The study was carried out with 42 patients who had a dual-chamber pacemaker or dual chamber ICD implanted, and the A-V interval was optimized by impedance cardiography. Left-ventricular pump function was determined by echocardiography, and the patients were divided into a group with maintained left-ventricular pump function (EF ≥50%) and another with limited (EF <50%). The criteria for inclusion were: 1. dual-chamber pacemaker or ICD; 2. sinus rhythm, and 3. consent. In all the patients the A-V intervals were programmed from 80-120 ms in steps of 20 ms or at the standard A-V interval (150 ms) and with their own conduction system (VVI 30/min.). For each A-V interval the mean stroke volume was determined in the steady state after 1 minute at the earliest. Results: The 42 patients in the study (33 men, 9 women; average age 66.8 ± 7.7 years, min. 47, max. 84 years) showed values of 45 ± 17 % for the mean ejection fraction (EF) during echocardiography. When the A-V interval was optimized, the stroke volume showed significantly higher values (74 ± 14 p <0001) than at the standard A-V interval (65± 13.5). The least-favourable A-V interval resulted in the significantly lowest stroke volume (least-favourable A-V interval 62.0 ±11.8 ms, optimum A-V interval 74 ± 14 p<0001). On average, the optimized A-V interval was significantly shorter than the least-favourable A-V interval (optimum A-V interval 103 ms ± 25, least-favourable A-V interval 129 ± 28 ms p<0001). In patients with an EF ≥ 50%, the optimized A-V interval was significantly shorter (96 +19.5) than in patients with an EF < 50% (109.5 ± 28 p= 0.048). Conclusions: It is possible to significantly improve the stroke volume acutely, at rest, by optimizing the A-V interval. There is no such thing as a universally optimum A-V interval; it is necessary to optimize it individually, the optimized A-V interval being in the shorter A-V conduction time range in both patients with an EF of ≥ 50% and those with an EF < 50%. Patients with limited LV pump function (EF < 50%) have significantly longer optimized A-V intervals than those whose LV function is not restricted.
Dual-chamber pacemaker
AV-Optimierung
Optimizing AV- Delay
2-Kammerschrittmacher
Impedanzkardiographie
Medizin, Gesundheit
Impedance cardiography
Akute hämodynamische Auswirkung der Optimierung des AV-Intervalls mit der Impedanzkardiographie bei Zwei-Kammerstimulation
Daralammouri, Yunis
topic Dual-chamber pacemaker
AV-Optimierung
Optimizing AV- Delay
2-Kammerschrittmacher
Impedanzkardiographie
Medizin, Gesundheit
Impedance cardiography
title Akute hämodynamische Auswirkung der Optimierung des AV-Intervalls mit der Impedanzkardiographie bei Zwei-Kammerstimulation
title_short Akute hämodynamische Auswirkung der Optimierung des AV-Intervalls mit der Impedanzkardiographie bei Zwei-Kammerstimulation
title_full Akute hämodynamische Auswirkung der Optimierung des AV-Intervalls mit der Impedanzkardiographie bei Zwei-Kammerstimulation
title_fullStr Akute hämodynamische Auswirkung der Optimierung des AV-Intervalls mit der Impedanzkardiographie bei Zwei-Kammerstimulation
title_full_unstemmed Akute hämodynamische Auswirkung der Optimierung des AV-Intervalls mit der Impedanzkardiographie bei Zwei-Kammerstimulation
title_sort Akute hämodynamische Auswirkung der Optimierung des AV-Intervalls mit der Impedanzkardiographie bei Zwei-Kammerstimulation
title_alt Acute haemodynamic effects of optimizing the A-V interval with impedance cardiography in dual-chamber stimulation
publisher Philipps-Universität Marburg
building Medizin
ref_str_mv references
publishDate 2011
era_facet 2011
description Akute hämodynamische Auswirkung der Optimierung des AV-Intervalls mit der Impedanzkardiographie bei Zweikammerstimulation Abstract: Hintergrund: Eine Optimierung des AV- Intervalls bei Zweikammerstimulation kann zu einer Verbesserung der Hämodynamik führen. Die Beurteilung der Hämodynamik kann mittels invasiver und nichtinvasiver Verfahren erfolgen. Eine mögliche Methode ist die Impedanzkardiographie, bei der kardiale Voluminaänderungen registriert werden. Ziel dieser Arbeit war eine Untersuchung der akuten hämodynamischen Effekte unterschiedlich lang programmierter AV- Intervalle bei 2- Kammerstimulation ermittelt durch Bestimmung des Herzschlagvolumens mit der Impedanzkardiographie. Methoden: Eingeschlossen wurden 42 Patienten, die einen Zweikammer-Schrittmacher bzw. 2-Kammer-ICD implantiert bekommen hatten, aufgenommen und es wurde eine Optimierung des AV- Intervalls mittels Impedanzkardiographie vorgenommen. Die linksventrikulären Pumpfunktion wurde echokardiographisch ermittelt und die Patienten in eine Gruppe mit erhaltener linksventrikulärer Pumpfunktion (LVEF) ( EF ≥50%) oder eingeschränkter LVEF ( EF <50%) eingeteilt Die Einschlusskriterien waren: 1. Zweikammer-Schrittmacher bzw. ICD 2. Sinusrhythmus und 3. Einverständnis. Bei allen Patienten wurden die AV-Intervalle von 80-120 ms in Schritten von 20 ms sowie das Standard-AV-Intervall (150ms) und die eigene Überleitung (VVI 30/min.) programmiert. Bei jedem AV-Intervall wurde im Steady-state nach frühestens 1 Minute. das mittlere Herzschlagvolumen bestimmt. Resultate: Die 42 untersuchten Patienten (33 Männer, 9 Frauen, mittleres Alter 66,8 ± 7,7 Jahre, min. 47, max 84 J.). zeigten in der Echokardiographie für die mittlere Ejektionsfraktion (EF) Werte von 45 ± 17 %. Das Herzschlagvolumen zeigte bei optimalem AV-Intervall signifikant höhere Werte (74 ± 14 p <0001) als beim Standard-AV-Intervall (65± 13,5). Für das ungünstigste AV-Intervall ergab sich das signifikant niedrigste Herzschlagvolumen (ungünstigstes AV-Intervall 62,0 ±11,8 ms, optimales AV-Intervall 74 ± 14 p<0001). Das optimierte AV-Intervall war im Mittel signifikant niedriger als das ungünstigstes AV-Intervall (optimales AV-Intervall 103 ms ±25, ungünstiges AV-Intervall 129 ± 28 ms p<0001). Bei Patienten mit einer EF ≥ 50% ergab sich eine signifikant niedrigere optimierte AV-Zeit (96 +19,5) als für Patienten mit einer EF < 50% (109,5 ± 28 p= 0,048). Schlussfolgerung: Mit einem optimierten AV-Intervall kann das Herzschlagvolumen in Ruhe akut signifikant verbessert werden. Hierbei gibt es kein universell optimales AV-Intervall, sondern es ist eine individuelle Optimierung erforderlich, wobei das optimierte AV-Intervall sowohl bei Patienten mit einer EF von ≥ 50% als auch < 50% jeweils im Bereich niedrigerer AV-Überleitungszeiten gefunden werden kann. Patienten mit eingeschränkter LV-Pumpfunktion (EF < 50%) haben dabei signifikant höhere optimierte AV-Zeiten als Patienten mit nichteingeschränkter LV-Funktion.
author2 Vogt, Sebastian (Prof. Dr.)
author2_role ths
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open_access
doc-type:doctoralThesis
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dewey-raw 610
dewey-search 610
genre Medical sciences, Medicine
genre_facet Medical sciences, Medicine
topic_facet Medizin, Gesundheit
first_indexed 2011-03-04T00:00:00Z
url http://archiv.ub.uni-marburg.de/diss/z2011/0069/pdf/dyd.pdf
language German
license_str http://archiv.ub.uni-marburg.de/adm/urhg.html
author Daralammouri, Yunis
format Dissertation
last_indexed 2011-08-08T23:59:59Z
doi_str_mv http://dx.doi.org/10.17192/z2011.0069
edition http://dx.doi.org/10.17192/z2011.0069
institution Medizin
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spelling diss/z2011/0069 Acute haemodynamic effects of optimizing the A-V interval with impedance cardiography in dual-chamber stimulation Background: Optimizing the A-V interval in dual-chamber stimulation may improve haemodynamics. Haemodynamic evaluation can be conducted by invasive or non-invasive procedures. One possible method is impedance cardiography, in which changes in cardiac volumes are recorded. The objective of this study was to analyze the acute haemodynamic effects of A-V intervals programmed at different lengths in dual-chamber stimulation, ascertained by determining stroke volume with impedance cardiography. Methods: The study was carried out with 42 patients who had a dual-chamber pacemaker or dual chamber ICD implanted, and the A-V interval was optimized by impedance cardiography. Left-ventricular pump function was determined by echocardiography, and the patients were divided into a group with maintained left-ventricular pump function (EF ≥50%) and another with limited (EF <50%). The criteria for inclusion were: 1. dual-chamber pacemaker or ICD; 2. sinus rhythm, and 3. consent. In all the patients the A-V intervals were programmed from 80-120 ms in steps of 20 ms or at the standard A-V interval (150 ms) and with their own conduction system (VVI 30/min.). For each A-V interval the mean stroke volume was determined in the steady state after 1 minute at the earliest. Results: The 42 patients in the study (33 men, 9 women; average age 66.8 ± 7.7 years, min. 47, max. 84 years) showed values of 45 ± 17 % for the mean ejection fraction (EF) during echocardiography. When the A-V interval was optimized, the stroke volume showed significantly higher values (74 ± 14 p <0001) than at the standard A-V interval (65± 13.5). The least-favourable A-V interval resulted in the significantly lowest stroke volume (least-favourable A-V interval 62.0 ±11.8 ms, optimum A-V interval 74 ± 14 p<0001). On average, the optimized A-V interval was significantly shorter than the least-favourable A-V interval (optimum A-V interval 103 ms ± 25, least-favourable A-V interval 129 ± 28 ms p<0001). In patients with an EF ≥ 50%, the optimized A-V interval was significantly shorter (96 +19.5) than in patients with an EF < 50% (109.5 ± 28 p= 0.048). Conclusions: It is possible to significantly improve the stroke volume acutely, at rest, by optimizing the A-V interval. There is no such thing as a universally optimum A-V interval; it is necessary to optimize it individually, the optimized A-V interval being in the shorter A-V conduction time range in both patients with an EF of ≥ 50% and those with an EF < 50%. 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"Assessment of the optimal atrioventricular delay in patients with dual-chamber pacemakers using impedance cardiography and Doppler echocardiography." J Clin Basic Cardiol (1999) 2:237–40. 1999 Assessment of the optimal atrioventricular delay in patients with dual-chamber pacemakers using impedance cardiography and Doppler echocardiography 2011 Akute hämodynamische Auswirkung der Optimierung des AV-Intervalls mit der Impedanzkardiographie bei Zweikammerstimulation Abstract: Hintergrund: Eine Optimierung des AV- Intervalls bei Zweikammerstimulation kann zu einer Verbesserung der Hämodynamik führen. Die Beurteilung der Hämodynamik kann mittels invasiver und nichtinvasiver Verfahren erfolgen. Eine mögliche Methode ist die Impedanzkardiographie, bei der kardiale Voluminaänderungen registriert werden. Ziel dieser Arbeit war eine Untersuchung der akuten hämodynamischen Effekte unterschiedlich lang programmierter AV- Intervalle bei 2- Kammerstimulation ermittelt durch Bestimmung des Herzschlagvolumens mit der Impedanzkardiographie. Methoden: Eingeschlossen wurden 42 Patienten, die einen Zweikammer-Schrittmacher bzw. 2-Kammer-ICD implantiert bekommen hatten, aufgenommen und es wurde eine Optimierung des AV- Intervalls mittels Impedanzkardiographie vorgenommen. Die linksventrikulären Pumpfunktion wurde echokardiographisch ermittelt und die Patienten in eine Gruppe mit erhaltener linksventrikulärer Pumpfunktion (LVEF) ( EF ≥50%) oder eingeschränkter LVEF ( EF <50%) eingeteilt Die Einschlusskriterien waren: 1. Zweikammer-Schrittmacher bzw. ICD 2. Sinusrhythmus und 3. Einverständnis. Bei allen Patienten wurden die AV-Intervalle von 80-120 ms in Schritten von 20 ms sowie das Standard-AV-Intervall (150ms) und die eigene Überleitung (VVI 30/min.) programmiert. Bei jedem AV-Intervall wurde im Steady-state nach frühestens 1 Minute. das mittlere Herzschlagvolumen bestimmt. Resultate: Die 42 untersuchten Patienten (33 Männer, 9 Frauen, mittleres Alter 66,8 ± 7,7 Jahre, min. 47, max 84 J.). zeigten in der Echokardiographie für die mittlere Ejektionsfraktion (EF) Werte von 45 ± 17 %. Das Herzschlagvolumen zeigte bei optimalem AV-Intervall signifikant höhere Werte (74 ± 14 p <0001) als beim Standard-AV-Intervall (65± 13,5). Für das ungünstigste AV-Intervall ergab sich das signifikant niedrigste Herzschlagvolumen (ungünstigstes AV-Intervall 62,0 ±11,8 ms, optimales AV-Intervall 74 ± 14 p<0001). Das optimierte AV-Intervall war im Mittel signifikant niedriger als das ungünstigstes AV-Intervall (optimales AV-Intervall 103 ms ±25, ungünstiges AV-Intervall 129 ± 28 ms p<0001). Bei Patienten mit einer EF ≥ 50% ergab sich eine signifikant niedrigere optimierte AV-Zeit (96 +19,5) als für Patienten mit einer EF < 50% (109,5 ± 28 p= 0,048). Schlussfolgerung: Mit einem optimierten AV-Intervall kann das Herzschlagvolumen in Ruhe akut signifikant verbessert werden. Hierbei gibt es kein universell optimales AV-Intervall, sondern es ist eine individuelle Optimierung erforderlich, wobei das optimierte AV-Intervall sowohl bei Patienten mit einer EF von ≥ 50% als auch < 50% jeweils im Bereich niedrigerer AV-Überleitungszeiten gefunden werden kann. Patienten mit eingeschränkter LV-Pumpfunktion (EF < 50%) haben dabei signifikant höhere optimierte AV-Zeiten als Patienten mit nichteingeschränkter LV-Funktion. 2011-03-04 2011-08-08 http://dx.doi.org/10.17192/z2011.0069 opus:3376 Philipps-Universität Marburg ths Prof. Dr. Vogt Sebastian Vogt, Sebastian (Prof. Dr.) Daralammouri, Yunis Daralammouri Yunis
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