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Related Experiment Video

Updated: Jul 16, 2026

Benefits of Cardiac Resynchronization Therapy in an Asynchronous Heart Failure Model Induced by Left Bundle Branch Ablation and Rapid Pacing

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Published on: December 11, 2017

A prospective comparison of AV delay programming methods for hemodynamic optimization during cardiac

Michael R Gold¹, Imran Niazi, Michael Giudici

¹Medical University of South Carolina, Charleston, South Carolina 29425, USA. goldmr@musc.edu

Journal of Cardiovascular Electrophysiology

|February 23, 2007

Summary

An electrogram (EGM) method accurately predicts the optimal atrioventricular delay (AVD) for cardiac resynchronization therapy (CRT). This technique simplifies AVD programming, potentially replacing echocardiography.

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Last Updated: Jul 16, 2026

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Area of Science:

Cardiology
Biomedical Engineering
Medical Device Technology

Background:

Optimal atrioventricular delay (AVD) programming is crucial for effective cardiac resynchronization therapy (CRT).
Current AVD programming methods include echocardiography, fixed delays, and electrogram (EGM) interval calculations.
Comparing these AVD programming strategies is essential for improving CRT outcomes.

Purpose of the Study:

To compare the acute effects of different AVD programming methods during CRT.
To evaluate the accuracy of noninvasive methods in predicting the optimal AVD.
To determine if an EGM-based method can reliably guide AVD programming.

Main Methods:

Studied 28 patients undergoing CRT implantation.
Used invasive measurements of left ventricular dP/dt to define optimal AVD in atrial sensed (AS) and atrial paced (AP) modes.
Compared optimal AVD with predictions from various noninvasive programming techniques.

Main Results:

Cardiac resynchronization therapy significantly increased LV dP/dt in both AS and AP modes (P < 0.001).
The electrogram (EGM) method demonstrated an excellent correlation with maximal achievable LV dP/dt (AS: R2=0.99, AP: R2=0.96).
The EGM-based method outperformed other tested techniques in predicting optimal AVD.

Conclusions:

An electrogram-based optimization method accurately predicts optimal AVD during CRT in both AS and AP modes.
This simple EGM technique is effective across a wide range of QRS intervals.
The EGM method may eliminate the need for echocardiography in AVD programming.