Author + information
- D. Cozma,
- C. Vacarescu,
- L. Petrescu and
- E.V. Goanţa
Assessing CRT device optimization according to exercise test performance in CRT patients.
Observational retrospective study of pts with CRT devices; periodic follow-up visits at intervals of 6 months: we collected clinical and echocardiography data, device interrogation and exercise test was performed. In the event of capture loss during exercise test subsequent programming was performed individualized for each patient to maximize BiV pacing.
Demographic data: 26 pts (16 male) aged 60.7±9.1 yo with dilated cardiomyopathy, NYHA functional class II and triple chamber CRT devices (CRT-P 21 pts, CRT-D 5 pts); sinus rhythm 96% of pts, permanent AF 4 % of pts. Follow-up period: 24.6±19.1 months. Cycloergometer exercise test was performed in all pts: loss of ventricular capture was noted in 27% of pts, individualized optimizing was done for each pt and the exercise test was repeated to ensure Biv pacing after reprogramming the device.
|Cycloergometer execise test – Bruce protocol|
|mean exercise load||5.4±1.2 METS (111.1±35.6 Watts)|
|peak heart rate (HR)||66±11.3 % of maximum age predicted HR (all pts under optimal betablocker treatment, 42% of pts with amiodarone association)|
|loss of ventricular capture|
(27 % of patients)
|physiological shortening of atrioventricular interval (AVI)||12 % of pts||CRT device reprogramming:|
|exceeding maximum tracking rate (MTR)||8 % of pts|
|loss of BiV pacing due to high ventricular response above lower later limit||7 % of pts|
A significant percent of pts need CRT device optimization to ensure biventricular pacing during exercise. Routine exercise test should be a standard approach to maximize the CRT response during follow-up.