Clinical Research in Cardiology

, Volume 109, Issue 1, pp 124–127 | Cite as

Sex differences in optimal atrioventricular delay in patients receiving cardiac resynchronization therapy

  • Mariëlle Kloosterman
  • Alexander H. MaassEmail author
Letter to the Editors


Individual optimization of the atrioventricular (AV) delay has been part of standard protocol in several landmark cardiac resynchronization therapy (CRT) trials. While optimized delays can result in acute improvements in left ventricular diastolic and systolic function [1, 2], the role of routine AV delay optimization remains unclear since large clinical trials failed to show long-term improvement in clinical and echocardiographic outcome [3, 4]. Furthermore, AV optimization is time-consuming, costly; optimization methods are subjected to a high degree of variability, and sometimes complexity; and a “gold standard’’ is missing. A survey by Gras et al. [5] demonstrated that nearly 58% of cardiologist do not optimize CRT devices after implantation. However, suboptimal programmed delays may result in a 10–15% decline in cardiac output over time [6], and optimal AV delay settings will differ from the manufacturer’s set interval in at least a subset of patients. This might be...


Compliance with ethical standard

Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Auricchio A, Ding J, Spinelli JC, Kramer AP, Salo RW, Hoersch W, KenKnight BH, Klein HU (2002) Cardiac resynchronization therapy restores optimal atrioventricular mechanical timing in heart failure patients with ventricular conduction delay. J Am Coll Cardiol 39:1163–1169CrossRefGoogle Scholar
  2. 2.
    Hardt SE, Yazdi SH, Bauer A, Filusch A, Korosoglou G, Hansen A, Bekeredjian R, Ehlermann P, Remppis A, Katus HA, Kuecherer HF (2007) Immediate and chronic effects of AV-delay optimization in patients with cardiac resynchronization therapy. Int J Cardiol 115:318–325CrossRefGoogle Scholar
  3. 3.
    Ellenbogen KA, Gold MR, Meyer TE, Fernndez Lozano I, Mittal S, Waggoner AD, Lemke B, Singh JP, Spinale FG, Van Eyk JE, Whitehill J, Weiner S, Bedi M, Rapkin J, Stein KM (2010) Primary results from the SmartDelay determined AV optimization: a comparison to other AV delay methods used in cardiac resynchronization therapy (SMART-AV) trial: a randomized trial comparing empirical, echocardiography-guided, and algorithmic atrioventricular delay programming in cardiac resynchronization therapy. Circulation 122:2660–2668CrossRefGoogle Scholar
  4. 4.
    Martin DO, Lemke B, Birnie D, Krum H, Lee KL, Aonuma K, Gasparini M, Starling RC, Milasinovic G, Rogers T, Sambelashvili A, Gorcsan J 3rd, Houmsse M, Adaptive CRT Study Investigators (2012) Investigation of a novel algorithm for synchronized left-ventricular pacing and ambulatory optimization of cardiac resynchronization therapy: results of the adaptive CRT trial. Heart Rhythm 9:1807–1814CrossRefGoogle Scholar
  5. 5.
    Gras D, Gupta MS, Boulogne E, Guzzo L, Abraham WT (2009) Optimization of AV and VV delays in the real-world CRT patient population: an international survey on current clinical practice. Pacing Clin Electrophysiol 32(Suppl 1):S236–S239CrossRefGoogle Scholar
  6. 6.
    Auricchio A, Stellbrink C, Sack S, Block M, Vogt J, Bakker P, Huth C, Schondube F, Wolfhard U, Bocker D, Krahnefeld O, Kirkels H, Pacing Therapies in Congestive Heart Failure (PATH-CHF) Study Group (2002) Long-term clinical effect of hemodynamically optimized cardiac resynchronization therapy in patients with heart failure and ventricular conduction delay. J Am Coll Cardiol 39:2026–2033CrossRefGoogle Scholar
  7. 7.
    Brignole M, Auricchio A, Baron-Esquivias G, Bordachar P, Boriani G, Breithardt OA, Cleland J, Deharo JC, Delgado V, Elliott PM, Gorenek B, Israel CW, Leclercq C, Linde C, Mont L, Padeletti L, Sutton R, Vardas PE, ESC Committee for Practice Guidelines (CPG), Zamorano JL, Achenbach S, Baumgartner H, Bax JJ, Bueno H, Dean V, Deaton C, Erol C, Fagard R, Ferrari R, Hasdai D, Hoes AW, Kirchhof P, Knuuti J, Kolh P, Lancellotti P, Linhart A, Nihoyannopoulos P, Piepoli MF, Ponikowski P, Sirnes PA, Tamargo JL, Tendera M, Torbicki A, Wijns W, Windecker S, Document Reviewers, Kirchhof P, Blomstrom-Lundqvist C, Badano LP, Aliyev F, Bansch D, Baumgartner H, Bsata W, Buser P, Charron P, Daubert JC, Dobreanu D, Faerestrand S, Hasdai D, Hoes AW, Le Heuzey JY, Mavrakis H, McDonagh T, Merino JL, Nawar MM, Nielsen JC, Pieske B, Poposka L, Ruschitzka F, Tendera M, Van Gelder IC, Wilson CM (2013) 2013 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy: the Task Force on cardiac pacing and resynchronization therapy of the European Society of Cardiology (ESC). Developed in collaboration with the European Heart Rhythm Association (EHRA). Eur Heart J 34:2281–2329CrossRefGoogle Scholar
  8. 8.
    Kerlan JE, Sawhney NS, Waggoner AD, Chawla MK, Garhwal S, Osborn JL, Faddis MN (2006) Prospective comparison of echocardiographic atrioventricular delay optimization methods for cardiac resynchronization therapy. Heart Rhythm 3:148–154CrossRefGoogle Scholar
  9. 9.
    Gold MR, Niazi I, Giudici M, Leman RB, Sturdivant JL, Kim MH, Yu Y, Ding J, Waggoner AD (2007) A prospective comparison of AV delay programming methods for hemodynamic optimization during cardiac resynchronization therapy. J Cardiovasc Electrophysiol 18:490–496CrossRefGoogle Scholar
  10. 10.
    International Working Group on Quantitative Optimization, Sohaib SM, Whinnett ZI, Ellenbogen KA, Stellbrink C, Quinn TA, Bogaard MD, Bordachar P, van Gelder BM, van Geldorp IE, Linde C, Meine M, Prinzen FW, Turcott RG, Spotnitz HM, Wichterle D, Francis DP (2013) Cardiac resynchronisation therapy optimisation strategies: systematic classification, detailed analysis, minimum standards and a roadmap for development and testing. Int J Cardiol 170:118–131CrossRefGoogle Scholar
  11. 11.
    Gold MR, Yu Y, Singh JP, Birgersdotter-Green U, Stein KM, Wold N, Meyer TE, Ellenbogen KA (2018) Effect of interventricular electrical delay on atrioventricular optimization for cardiac resynchronization therapy. Circ Arrhythm Electrophysiol 11:e006055CrossRefGoogle Scholar
  12. 12.
    Cheng A, Gold MR, Waggoner AD, Meyer TE, Seth M, Rapkin J, Stein KM, Ellenbogen KA (2012) Potential mechanisms underlying the effect of gender on response to cardiac resynchronization therapy: insights from the SMART-AV multicenter trial. Heart Rhythm 9:736–741CrossRefGoogle Scholar
  13. 13.
    Maass AH, Vernooy K, Wijers SC, van ‘t Sant J, Cramer MJ, Meine M, Allaart CP, De Lange FJ, Prinzen FW, Gerritse B, Erdtsieck E, Scheerder COS, Hill MRS, Scholten M, Kloosterman M, Ter Horst IAH, Voors AA, Vos MA, Rienstra M, Van Gelder IC (2018) Refining success of cardiac resynchronization therapy using a simple score predicting the amount of reverse ventricular remodelling: results from the Markers and Response to CRT (MARC) study. Europace 20:e1–e10CrossRefGoogle Scholar
  14. 14.
    Halbfass P, Sonne K, Nentwich K, Ene E, Deneke T (2018) Current developments in cardiac rhythm management devices. Clin Res Cardiol 107:100–104CrossRefGoogle Scholar
  15. 15.
    D’Ancona G, Safak E, Senges J, Hochadel M, Nguyen VL, Perings C, Jung W, Spitzer S, Eckardt L, Brachmann J, Seidl K, Hink HU, Ince H, Ortak J (2017) Activation of remote monitoring for cardiac implantable electronic devices: small dog for tall weeds. Clin Res Cardiol 106:833–839CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of CardiologyUniversity of Groningen, University Medical Center GroningenGroningenThe Netherlands

Personalised recommendations