Comparison of echocardiography and device based algorithm for atrio-ventricular delay optimization in heart block patients

AIM: To compare the atrio-ventricular (AV/PV) delay optimization by echocardiography and intra-cardiac electrocardiogram (IEGM) based QuickOpt algorithm in complete heart block (CHB) patients, implanted with a dual chamber pacemaker. METHODS: We prospectively enrolled 20 patients (age 59.45 +/- 18.1 years; male: 65%) with CHB, who were implanted with a dual chamber pacemaker. The left ventricular outflow tract velocity time-integral was measured after AV/PV delay optimization by both echocardiography and QuickOpt algorithm method. Bland-Altman analysis was used for agreement between the two techniques. RESULTS: The optimal AV and PV delay determined by echocardiography was 155.5 +/- 14.68 ms and 122.5 +/- 17.73 ms (P < 0.0001), respectively and by QuickOpt method was 167.5 +/- 16.73 and 117.5 ms +/- 9.10 ms (P < 0.0001), respectively. A good agreement was observed between optimal AV and PV delay as measured by two methods. However, the correlation of the optimal AV (r = 0.0689, P = 0.77) and PV (r = 0.2689, P = 0.25) intervals measured by the two techniques was poor. The time required for AV/PV optimization was 45.26 +/- 1.73 min by echocardiography and 0.44 +/- 0.08 min by QuickOpt method (P < 0.0001). CONCLUSION: The programmer based IEGM method is an automated, quick, easier and reliable alternative to echocardiography for the optimization of AV/PV delay in CHB patients, implanted with a dual chamber pacemaker.