Utilization of electrocardiographic P-wave duration for AV interval optimization in dual-chamber pacemakers

Dan Sorajja, Mayurkumar D. Bhakta, Luis Scott, Gregory T. Altemose, Komandoor Srivathsan

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background: Empiric programming of the atrio-ventricular (AV) delay is commonly performed during pacemaker implantation. Transmitral flow assessment by Doppler echocardiography can be used to find the optimal AV delay by Ritter's method, but this cannot easily be performed during pacemaker implantation. We sought to determine a non-invasive surrogate for this assessment. Since electrocardiographic P-wave duration estimates atrial activation time, we hypothesized this measurement may provide a more appropriate basis for programming AV intervals. Methods: A total of 19 patients were examined at the time of dual chamber pacemaker implantation, 13 (68%) being male with a mean age of 77. Each patient had the optimal AV interval determined by Ritter's method. The P-wave duration was measured independently on electrocardiograms using MUSE® Cardiology Information System (version 7.1.1). The relationship between P-wave duration and the optimal AV interval was analyzed. Results: The P-wave duration and optimal AV delay were related by a correlation coefficient of 0.815 and a correction factor of 1.26. The mean BMI was 27. The presence of hypertension, atrial fibrillation, and valvular heart disease was 13 (68%), 3 (16%), and 2 (11%) respectively. Mean echocardiographic parameters included an ejection fraction of 58%, left atrial index of 32 ml/m2, and diastolic dysfunction grade 1 (out of 4). Conclusions: In patients with dual chamber pacemakers in AV sequentially paced mode and normal EF, electrocardiographic P-wave duration correlates to the optimal AV delay by Ritter's method by a factor of 1.26.

Original languageEnglish (US)
Pages (from-to)383-392
Number of pages10
JournalIndian Pacing and Electrophysiology Journal
Volume10
Issue number9
StatePublished - Sep 1 2010

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Heart Valve Diseases
Doppler Echocardiography
Cardiology
Information Systems
Atrial Fibrillation
Electrocardiography
Hypertension
factor EF-P

Keywords

  • AV interval
  • Echocardiography
  • Electrocardiogram
  • Optimization
  • Pacing

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Utilization of electrocardiographic P-wave duration for AV interval optimization in dual-chamber pacemakers. / Sorajja, Dan; Bhakta, Mayurkumar D.; Scott, Luis; Altemose, Gregory T.; Srivathsan, Komandoor.

In: Indian Pacing and Electrophysiology Journal, Vol. 10, No. 9, 01.09.2010, p. 383-392.

Research output: Contribution to journalArticle

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N2 - Background: Empiric programming of the atrio-ventricular (AV) delay is commonly performed during pacemaker implantation. Transmitral flow assessment by Doppler echocardiography can be used to find the optimal AV delay by Ritter's method, but this cannot easily be performed during pacemaker implantation. We sought to determine a non-invasive surrogate for this assessment. Since electrocardiographic P-wave duration estimates atrial activation time, we hypothesized this measurement may provide a more appropriate basis for programming AV intervals. Methods: A total of 19 patients were examined at the time of dual chamber pacemaker implantation, 13 (68%) being male with a mean age of 77. Each patient had the optimal AV interval determined by Ritter's method. The P-wave duration was measured independently on electrocardiograms using MUSE® Cardiology Information System (version 7.1.1). The relationship between P-wave duration and the optimal AV interval was analyzed. Results: The P-wave duration and optimal AV delay were related by a correlation coefficient of 0.815 and a correction factor of 1.26. The mean BMI was 27. The presence of hypertension, atrial fibrillation, and valvular heart disease was 13 (68%), 3 (16%), and 2 (11%) respectively. Mean echocardiographic parameters included an ejection fraction of 58%, left atrial index of 32 ml/m2, and diastolic dysfunction grade 1 (out of 4). Conclusions: In patients with dual chamber pacemakers in AV sequentially paced mode and normal EF, electrocardiographic P-wave duration correlates to the optimal AV delay by Ritter's method by a factor of 1.26.

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