Opportunities for optimization of biventricular pacing using an implanted hemodynamic monitor

Optimization of pacing parameters such as AV delay is important in heart failure (HF) patients treated with cardiac resynchronization therapy (CRT). We hypothesized, that an implantable hemodynamic monitor (IHM) might be helpful in identifying the optimal AV-delay. 10 patients with HF, successfully treated by CRT were also implanted with an IHM that continuously records heart rate, activity, RV pressures and an estimation of the pulmonary artery diastolic pressure (ePAD). First, AV delays were optimized by echo, then different AV-delays (50-190 ms) were randomly programmed using steps of 20 ms. Using the IHM, a U-shaped curve was obtained with an optimal AV delay slightly longer as compared with echo. Shortening the AV interval resulted in increased ePAD values. In future, CRT optimization may be guided by hemodynamic sensors recording basic cardiovascular measures during daily activities of living