Pacing at accelerated heart rate during echocardiography-guided atrioventricular optimisation following cardiac resynchronisation therapy

Introduction Although echo-guided atrioventricular optimisation (AVO) is standardly performed at rest, this approach may not provide optimal AV synchrony during daily activities. Material and methods The AVO protocol at one of two hospital campuses had been modified to be performed while pacing at an accelerated heart rate. We tested if this approach would improve the yield from AVO compared to the other campus, where AVO was performed at the intrinsic sinus rate. Results Between campuses, no significant differences were seen in demographics, chamber sizes, left ventricular ejection fraction, and diastolic function grade. Those having AVO at C2 were more likely to demonstrate "fusion prone" physiology (36% vs. 9%; p = 0.006) and were more likely to display either "truncation- or fusion-prone" physiology (58% vs. 27%; p = 0.007). Conclusions When AVO was performed at an accelerated heart rate, patients with "truncation-prone" or "fusion-prone" physiology were identified more readily.