Primjena intrakardijalnih elektrograma u optimizaciji resinkronizacijskoga elektrostimulatora srca

doctoral thesis

• Author: Borka Pezo Nikolić; VIAF: 305665079
• Mentor: Jadranka Šeparović-Hanževački (mentor)
• Committee member: nije dostupno (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; Zagreb
• Defense date and country: 2017-12-29, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences
• Universal decimal classification (UDC): 61 - Medical sciences

Abstract

Optimizacija intrakardijalnih intervala stimulacije u resinkronizacijskim elektrostimulatorima
ovisi trenutno o vremenski dugotrajnoj ultrazvučnoj metodi. Metoda automatskih intrakardijalnih
elektrograma (IEGM) za optimizaciju atrioventrikulskog i intereventrikulskog intervala razvijena
od St. Jude može se koristiti za vrijeme rutinske kontrole. Neki proizvođači nemaju automatski
IEGM sistem atrioventrikulske (AV) i interventrikulske (VV) optimizacije u srčanoj
resinkronzacijskoj terapiji (CRT). Cilj ovog istraživanja bio je procijeniti dijagnostičku vrijednost
ručne IEGM metode kod pacijenta s ugrađenim CRT-om.
U naše istraživanje uključeno je 48 pacijenata kojima je prethodno ugrađen Medtronic Syncra
CRT. Mjesec dana nakon ugradnje svi pacijenti su došli na standardnu kontrolu
elektrostimulatora nakon čega je učinjena optimizacija CRT-a, prvo IEGM metodom a potom
ultrazvučno. Prosječna dob pacijenta bila je 60,7 ± 11,8 godine od čega su 33 (68,8%) muškarci.
Nakon ugradnje CRT ,ejekcijska frakcija lijeve klijetke narasla je s 28,0 ± 7,9 % na 39,1 ± 11,0
% (P<0.001). Najveći integral brzine protoka u izgonskom traktu lijeve klijetke (LVOT VTI)
dobiven je pri VV intervalu od 20 – 50 ms lijeve preekscitacije. Postoji snažna korelacija između
trajanja VV intervala dobivenog ultrazvučno i IEGM (ρ = 0.823, P<0.001). Nismo našli
statistički značajnu razliku AV ,VV LVOT VTI vrijednosti dobivenih ultrazvučno i IEGM
metodom. Ipak, IEGM metoda zahtjeva bitno manje vremena od ultrazvučne metode [20 (10 –
28) vs. 40 (35 – 60) minuta, P<0.001].

Abstract (english)

Intracardiac delay optimization of biventricular pacing devices currently relies on timeconsuming
echocardiographic measurements. Automatic intracardiac electrogram (IEGM)
method for atrioventricular (AV) and interventricular (VV) delay optimization was developed by
St. Jude, which can be performed during routine device follow-up. Some manufacturers do not
provide automated intracardiac electrogram (IEGM) systems for AV and VVdelay optimization
in cardiac resynchronization therapy (CRT). We aimed to evaluate the diagnostic accuracy of
manual IEGM method in patients undergoing CRT.
We included 48 patients previously implanted with Medtronic Syncra, cardiac resynchronization
therapy devices. One month after CRT implantation all patients underwent standard device
interrogation followed by optimization of the CRT pacemaker settings by IEGM method and by
echocardiography.
Patients had a mean age of 60,7 ± 11,8 years and 33 (68,8%) were males. After the CRT
implantation, ejection fraction of the left ventricle increased from 28,0 ± 7,9 % to 39,1 ± 11,0 %
(P<0.001). Optimal aortic velocity time integral (AVTI) was obtained when VV was set to 20 –
50 ms left ventricular pre-activation. There was a strong correlation between VV values
determined by echocardiography and IEGM (ρ = 0.823, P<0.001). We found no significant
difference in sensed atrioventricular interval, paced atrioventricular interval, LVOT VTI and VV
values between echocardiography and IEGM method. However, IEGM was significantly less
time consuming than echocardiography [20 (10 – 28) vs. 40 (35 – 60) minutes, P<0.001].
The automated programmer-based IEGM method provides a reliable and simpler alternative
to standard techniques for CRT optimization. Our study indicates that manual IEGM method may
be good alternative to echocardiography and automated IEGM method. It also emphasizes the
need for implementation of automated IEGM systems by all CRT device manufacturers.

• Keywords: medicina
• Keywords (english): medicine
• Language: croatian
• URN:NBN: urn:nbn:hr:105:329470
• Study programme: Title: Biomedicine and Health Sciences; Study programme type: university; Study level: postgraduate; Academic / professional title: doktor/doktorica znanosti, područje biomedicine i zdravstva (doktor/doktorica znanosti, područje biomedicine i zdravstva)
• Type of resource: Text
• Extent: 88 str.
• File origin: Born digital
• Access conditions: Open access
• Created on: 2023-05-05 08:21:43