Effects of AV delay programming on ventricular resynchronisation: role of radionuclide ventriculography

Purpose: Optimal atrioventricular delay (AVD) setting for cardiac resynchronisation therapy, i.e. biventricular pacing in patients with heart failure, remains a formidable challenge. Thus, the purpose of this study was to evaluate the effects of different AVD on inter- and intra-ventricular resynchronisation using phase histograms of radionuclide ventriculography (RNV). Methods: In 17 consecutive patients (mean age 64 ± 6years), RNV was performed 236 ± 350days after pacemaker implantation for cardiac resynchronisation therapy. Images were acquired during atrial pacing at 80bpm and during biventricular pacing with AVD ranging from 80 to 160ms. Inter-ventricular dyssynchrony was measured by the delay between the mean phase angles of the left and right ventricles. Intra-ventricular dyssynchrony was measured by the standard deviation (SD) of left ventricular phase histograms. Results: Left ventricular (LV) ejection fraction (EF) was inversely correlated to LV dyssynchrony (SD of LV phase histogram, R = −0.82, p < 0.0001). However, the increase in LVEF by biventricular pacing (mean +4.4 ± 4%) showed only modest correlation to the resulting resynchronisation effect (characterised by a −13 ± 8° decrease in LV phase histogram SD, R = −0.38, p < 0.0001). Conclusion: RNV is helpful in optimising pacing parameters for resynchronisation therapy. Varying AVD did not have a major impact on intra- or inter-ventricular resynchronisation. Thus, the benefit of AVD-based LVEF optimisation seems to result from atrioventricular resynchronisation