AV delays optimization

Medtronic Device: CRT

Theoritical features / Basic concepts

  Basic concepts : AV delay and VV delay optimization AV delay optimization VV delay optimization LV pacing alone or biventricular pacing ? AdaptivCRT algorithm   AV DELAY AND VV DELAY OPTIMIZATION Biventricular resynchronization provides significant clinical benefit, a reverse remodeling with reduction of the cardiac volume, and a decrease in morbidity and mortality in heart failure patients with wide QRS. The main limitation of this therapy is that all studies found a significant percentage of patients that do not respond favorably to the resynchronization therapy. Different approaches have been proposed to reduce the percentage of non-responders. Once the patient is implanted, a sub-optimal adjustment of the CRT device can contribute to alter the quality of the response. The principle...

Medtronic paths associated with this specificity

64-year-old man implanted with a triple-chamber defibrillator Viva XT CRT-D for idiopathic dilated cardiomyopathy with a left bundle branch block; follow-up 3 months post implant; non-responder patient with unchanged symptomatology (shortness of breath during daily activities); device interrogation reveals 100% of biventricular pacing.64-year-old man implanted with a triple-chamber defibrillator Viva XT CRT-D for idiopathic dilated cardiomyopathy with a left bundle branch b

64-year-old man implanted with a triple-chamber defibrillator Concerto II CRT-D with positioning of a Medtronic 4195 LV lead in a small lateral vein; complex implantation due to the small caliber of the veins + high threshold values + several pacing sites with a phrenic nerve capture.

70-year-old man implanted with a triple-chamber defibrillator Viva XT CRT-D and a Medtronic 4194 LV lead for ischemic cardiomyopathy with a left bundle branch block; follow-up 3 days after implant; LV threshold performed in various pacing configurations (pacing DDD 90 bpm, amplitude decrement, fixed pulse width of 0.4 ms).

62-year-old man implanted with a triple chamber defibrillator Viva Quad XT CRT-D connected to a quadripolar Medtronic 4298 LV lead for ischemic cardiomyopathy with left bundle branch block; the implantation procedure was difficult with few lateral veins of small caliber and a large inferior vein draining the lateral wall; presence of high threshold values in the apical portion of the lateral wall and phrenic nerve stimulation; positioning of a quadripolar lead; LV threshold

81-year-old man implanted with a triple chamber pacemaker Consulta CRT-P with bipolar RV and LV leads for severe ischemic cardiomyopathy with right bundle branch block; routine follow-up; the ECG shows two slightly different patterns of the paced QRS; LV pacing amplitude is set at 3.5 V/0.4 ms in a (distal) tip LV – ring (anode) RV.

64-year-old man implanted with a triple chamber defibrillator Concerto II CRT-D for ischemic cardiomyopathy with left bundle branch block; symptomatic phrenic nerve stimulation; pacing output set at 1.5 Volts/0.4 ms with a minimal margin on the pacing threshold but with no phrenic nerve stimulation; follow-up by remote monitoring; reception of an EGM tracing in the context of an Optivol alert, statistical report indicating a permanent biventricular pacing.

70-year-old man implanted with a triple chamber defibrillator Viva XT CRT-D for severe ischemic cardiomyopathy and left bundle branch block; good response to resynchronization therapy; two endocarditis episodes necessitated the complete removal of the system (first implanted on the left side, then on the right side); complete surgical re-implantation of a defibrillator with 2 coils, a bipolar atrial and RV lead and a bipolar LV lead; routine follow-up.

74-year-old man implanted with a triple chamber pacemaker Consulta CRT-P for idiopathic dilated cardiomyopathy with complete AV block; pacemaker interrogation 3 days post implant. 

66-year-old man implanted with a triple-chamber defibrillator Viva XT CRT-D for idiopathic dilated cardiomyopathy with complete AV block; pacemaker interrogation 3 days post implant.

76-year-old man implanted with a triple-chamber defibrillator Viva Quad XT CRT-D for ischemic cardiomyopathy with a left bundle branch block and a long PR interval; follow-up 6 months after implant.

65-year-old man implanted with a triple-chamber defibrillator Viva XT CRT-D for idiopathic dilated cardiomyopathy with left bundle branch block; 3 months post implant interrogation.

51-year-old man implanted with a triple-chamber defibrillator Consulta CRT-P for ischemic cardiomyopathy with left bundle branch block; excellent clinical response to resynchronization, a stress test (steps) is performed with the telemetry wand of the programmer placed over the device.

Young patient (24 years old) implanted with a triple-chamber pacemaker Consulta CRT-P for a complete congenital AV block; dizziness during exercise; stress test performed on an ergometer with the telemetry wand placed over the device.

64-year-old man implanted with a triple-chamber defibrillator Consulta CRT-D for ischemic cardiomyopathy with complete AV block; shortness of breath during exercise.

25-year-old patient, high-performance athlete (skiing and endurance sports), having undergone cardiac surgery (Tirone David valve surgery) as part of an aortic bicuspid condition; the intervention was complicated by the occurrence of a complete and permanent atrioventricular block; the patient underwent  implantation of a triple chamber VIVA CRT-P pacemaker by surgical epicardial access; after a 3-week rehabilitation period, he progressively resumed sports activities which was accompanied by

65-year-old man, implanted with a triple-chamber defibrillator Concerto II CRT-D for valvular cardiomyopathy with left bundle branch block; crosstalk and adjustment of atrial sensitivity at 0.5 mV; interrogation of the device demonstrating ventricular sensed cycles.

68-year-old man, implanted with a triple-chamber defibrillator Concerto II CRT-D for ischemic cardiomyopathy with complete AV bloc and episodes of atrial arrhythmias; implanted with a true (dedicated) bipolar ventricular lead in the inter-ventricular septum; several episodes of dizziness. 

77-year-old man, implanted with a triple-chamber defibrillator Consulta CRT-D for mitral valvular cardiomyopathy with left bundle branch block and long PR interval; routine follow-up 3 months after implantation; episodes of ventricular sensing are recorded; the right ventricular lead is implanted in the interventricular septum and is not displaced on chest X-ray. 

 

65-year-old man, implanted with a triple-chamber defibrillator Protecta XT CRT-D for primary cardiomyopathy with sinus dysfunction, left bundle branch block and long PR interval; routine follow-up 6 months after implantation; recording of spontaneous ventricular sensed event.

53-year-old woman implanted with a triple-chamber defibrillator Protecta XT CRT-D for ischemic cardiomyopathy with left bundle branch block; routine follow-up.

68-year-old man implanted with a triple-chamber defibrillator Viva XT CRT-D for dilated cardiomyopathy with atypical bundle branch block; routine follow-up; reduction of the percentage of biventricular pacing

68-year-old man implanted with a triple-chamber defibrillator Viva XT CRT-D for ischemic cardiomyopathy with left bundle branch block; non-responder to cardiac resynchronization; percentage of biventricular pacing at 78%.

47-year-old man implanted with a triple-chamber defibrillator Viva XT for dilated cardiomyopathy with left bundle branch block; routine follow-up; several episodes of non-sustained VT recorded by the device.

66-year-old man implanted with a triple chamber defibrillator Protecta XT for very severe ischemic cardiomyopathy with left bundle branch block; episode of cardiac decompensation and palpitations.

72-year-old man implanted with a triple-chamber defibrillator Viva XT CRT-D for ischemic cardiomyopathy with atypical bundle branch block and episodes of atrial fibrillation; device interrogation performed a few days after implant. 

69-year-old man implanted with a triple-chamber defibrillator Viva XT CRT-D for valvular cardiomyopathy with permanent AF (no atrial lead implanted) and a narrow QRS; device interrogation performed a few hours after the implant.

53-year-old man implanted with a triple-chamber defibrillator Consulta CRT-D for idiopathic cardiomyopathy with left bundle branch block; remote monitoring follow-up.

79-year-old man implanted with a triple-chamber defibrillator Consulta XT CRT-D for ischemic cardiomyopathy with a wide QRS (the device was implanted 8 years ago and already replaced once); the consultation is motivated by several electrical shocks received while he was working in his garden.