Imperial College London
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DrZacharyWhinnett

Faculty of Medicine, National Heart & Lung Institute

Reader in Cardiac Electrophysiology
 
 
 
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z.whinnett

 
 
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Location

 

South- NHLI Cardiovascular ScienceBlock B Hammersmith HospitalHammersmith Campus

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Summary

 

Publications

Citation

BibTex format

@article{Keene:2022:10.1111/pace.14434,
author = {Keene, D and Miyazawa, AA and Johal, M and Arnold, AD and Ali, N and Saqi, KA and March, K and Burden, L and Francis, DP and Whinnett, Z and Shun-Shin, MJ},
doi = {10.1111/pace.14434},
journal = {Pacing and Clinical Electrophysiology},
pages = {461--470},
title = {Optimizing atrio-ventricular delay in pacemakers using potentially implantable physiological biomarkers},
url = {http://dx.doi.org/10.1111/pace.14434},
volume = {45},
year = {2022}
}
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TY  - JOUR
AB  - BackgroundHemodynamically optimal atrioventricular (AV) delay can be derived by echocardiography or beat-by-beat blood pressure (BP) measurements, but analysis is labor intensive. Laser Doppler perfusion monitoring measures blood flow and can be incorporated into future implantable cardiac devices.We assess whether laser Doppler can be used instead of BP to optimize AV delay.MethodsFifty eight patients underwent 94 AV delay optimizations with biventricular or His-bundle pacing using laser Doppler and simultaneous noninvasive beat-by-beat BP. Optimal AV delay was defined using a curve of hemodynamic response to switching from AAI (reference state) to DDD (test state) at several AV delays (40–320 ms), with automatic quality control checking precision of the optimum.Five subsequent patients underwent an extended protocol to test the impact of greater numbers of alternations on optimization quality.Results55/94 optimizations passed quality control resulting in an optimal AV delay on laser Doppler similar to that derived by BP (median absolute deviation 12 ms).An extended protocol with increasing number of replicates consistently improved quality and reduced disagreement between laser Doppler and BP optima. With only five replicates, no optimization passed quality control, and the median absolute deviation would be 29 ms. These improved progressively until at 50 replicates, all optimizations passed quality control and the median absolute deviation was only 13 ms.ConclusionsLaser Doppler perfusion produces hemodynamic optima equivalent to BP. Quality control can be automatic. Adding more replicates, consistently improves quality. Future implantable devices could use such methods to dynamically and reliably optimize AV delays.
AU  - Keene,D
AU  - Miyazawa,AA
AU  - Johal,M
AU  - Arnold,AD
AU  - Ali,N
AU  - Saqi,KA
AU  - March,K
AU  - Burden,L
AU  - Francis,DP
AU  - Whinnett,Z
AU  - Shun-Shin,MJ
DO  - 10.1111/pace.14434
EP  - 470
PY  - 2022///
SN  - 0147-8389
SP  - 461
TI  - Optimizing atrio-ventricular delay in pacemakers using potentially implantable physiological biomarkers
T2  - Pacing and Clinical Electrophysiology
UR  - http://dx.doi.org/10.1111/pace.14434
UR  - https://www.webofscience.com/api/gateway?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000748287700001&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=1ba7043ffcc86c417c072aa74d649202
UR  - https://onlinelibrary.wiley.com/doi/10.1111/pace.14434
UR  - http://hdl.handle.net/10044/1/103121
VL  - 45
ER  -
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