Atrial mechanical contraction and ambulatory atrioventricular synchrony: Predictors from the OPTIVALL study.
J Cardiovasc Electrophysiol
; 34(9): 1904-1913, 2023 09.
Article
em En
| MEDLINE
| ID: mdl-37482952
ABSTRACT
INTRODUCTION:
The role that preprocedural factors have on atrioventricular synchrony (AVS) provided by leadless pacemakers requires investigation. METHODS ANDRESULTS:
We aimed to assess the correlation between mitral inflow echocardiographic parameters and p-wave morphology with the accelerometer A4 signal amplitude. We also sought to identify clinical and echocardiographic predictors of optimal ambulatory AVS (≥85% of cardiac cycles). Forty-three patients undergoing Micra AV implant from June 2020 to March 2023 were prospectively enrolled. Baseline echocardiogram and 12-lead resting ECG were performed. Device follow-up was scheduled at 24 h, 1, 3, and 6 months and yearly after the implant. Ambulatory AVS was studied with a 24 h Holter monitor performed at 3 months follow-up in 35 patients who remained in VDD mode. A4 signal amplitude at 1 month correlated to peak A wave velocity (r = .376; p = .024) at echocardiogram, but no relationship was found with peak A' wave velocity, E/A, or E'/A' ratio. P-wave amplitude in lead I and aVF correlated to A4 signal amplitude at 1- and 3-months follow-up, respectively. Median AVS during 24 h of daily activities was 85.6 ± 7.6% and remained stable up to 100 bpm. Twenty-three out of 35 patients (65.7%) reached optimal ambulatory AVS. There was no association between mitral inflow echocardiographic parameters and optimal AVS. Diabetes (OR 0.05, 95% CI 0.01-0.47; p = .009) and chronic obstructive pulmonary disease (COPD) (OR 0.06, 95% CI 0.01-0.63; p = .019) strongly predicted ambulatory AVS <85%.CONCLUSIONS:
Diabetes and COPD should be considered when selecting candidates for Micra AV. Measurements of pulsed wave Doppler mitral inflow do not systematically reflect the behavior of the A4 signal amplitude.Palavras-chave
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Marca-Passo Artificial
/
Fibrilação Atrial
Idioma:
En
Ano de publicação:
2023
Tipo de documento:
Article