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The impact of chronotropic incompetence on atrioventricular conduction times in heart failure patients

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Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

Abstract

Background

Intrinsic atrioventricular (AV) conduction is used to optimize AV intervals with cardiac resynchronization therapy (CRT) in most device algorithms. Atrial pacing and heart rate affect conduction times, but little is known regarding differeces among chronotropic incompetent(CI) and competent(CC) patients to guide programming.

Methods

RAVE was a multicenter prospective trial of CRT patients. Heart rate was increased with incremental atrial pacing and with submaximal exercise. According to the maximal heart rate achieved during exercise, patients were classified as either CI or CC. For CI patients, an additional symptom-limited exercise with rate-adaptive pacing activated was performed. Intracardiac intervals were measured from the implantable lead electrograms in multiple postures.

Results

There were 12 subjects with CI and 24 with CC. With atrial pacing, AV interval immediately increased and gradually increased with incremental atrial pacing in all patients. However, the changes in the atrial to right ventricular (ARV) and atrial to left ventricular (ALV) intervals with increasing atrial pacing rates were about threefold greater in CI patients compared to CC patients (24.3 ± 28.9 vs. 7.2 ± 5.5 ms/10 bpm for ARV and 22.7 ± 25.6 vs. 7.1 ± 5.7 ms/10 bpm for ALV in the standing position, p < 0.05). In CI pacing with rate-adaptive pacing during exercise, AV interval changes with paced heart rate were variable.

Conclusions

The AV response to overdrive atrial pacing at rest may provide a simple means of identifying chronotropic competence in CRT patients. For patients with CI, who often require rate-adaptive atrial pacing, rate-adaptive AV algorithms should be adjusted individually.

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Data Availability

The data that support the findings of this study are not openly available due to reasons of sensitivity and are available from the corresponding author upon reasonable request.

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Funding

This study was supported by Boston Scientific Corporation CRM, St. Paul, MN, USA.

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Authors and Affiliations

  1. Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China

    Hongxia Niu

  2. Boston Scientific, St Paul, MN, USA

    Yinghong Yu & Vasanth Ravikumar

  3. Division of Cardiology, Medical University of South Carolina, 30 Courtenay Drive, MSC 592, Charleston, SC, 29425, USA

    Michael R. Gold

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Correspondence to Michael R. Gold.

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Conflict of interest

Ms. Yu and Mr. Ravikumar are employees of Boston Scientific. Dr. Gold is a consultant to Boston Scientific and Medtronic and has funding for research trials from Abbott, Boston Scientific and Medtronic. Dr. Niu reports no conflicts.

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Niu, H., Yu, Y., Ravikumar, V. et al. The impact of chronotropic incompetence on atrioventricular conduction times in heart failure patients. J Interv Card Electrophysiol 66, 2055–2062 (2023). https://doi.org/10.1007/s10840-023-01545-5

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