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Related Concept Videos

Pulse rhythm01:30

Pulse rhythm

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Pulse rhythm refers to the pattern of pulsations within specific intervals, offering valuable insights into the regularity or irregularity of the heart's beats as observed through the pattern of pulsation within specific intervals. A regular pulse exhibits a consistent heart rate with uniform waveforms and pulsation force, variations of which can be classified as normal, weak, or bounding.
Conversely, an irregular pulse pattern is termed dysrhythmia, stemming from disruptions in cardiac...
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Related Experiment Video

Updated: Feb 19, 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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Tailoring device settings in cardiac resynchronization therapy using electrograms from pacing electrodes.

Elien B Engels1, Masih Mafi-Rad2, Ben J M Hermans1,3

  • 1Department of Physiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands.

Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology
|November 7, 2017
PubMed
Summary
This summary is machine-generated.

Optimal left ventricular (LV) fusion pacing, crucial for cardiac resynchronization therapy (CRT), can be achieved using electrogram (EGM)-based vectorloop (EGMV) analysis. This method, analyzing QRS amplitude, offers a potentially improved approach for individualizing CRT device settings.

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Area of Science:

  • Cardiology
  • Biomedical Engineering
  • Electrophysiology

Background:

  • Left ventricular (LV) fusion pacing is a key component of cardiac resynchronization therapy (CRT), aiming to improve cardiac function.
  • Optimizing LV fusion pacing necessitates precise adjustment of the atrioventricular (AV)-delay, specifically to the interval between atrial pacing and intrinsic right ventricular (RV) activation (Ap-RV).
  • Current methods for determining optimal AV-delay may not consistently yield the best CRT outcomes.

Purpose of the Study:

  • To explore the utility of electrogram (EGM)-based vectorloop (EGMV) analysis for achieving optimal LV fusion pacing during CRT.
  • To compare the effectiveness of EGMV-derived settings with conventional methods for AV-delay optimization.
  • To assess the impact of different AV-delay settings on LV contractility, measured by LV dP/dtmax.

Main Methods:

  • A prospective study of 28 patients undergoing CRT device implantation.
  • Recording of LV dP/dtmax, 12-lead ECG, and unipolar EGMs during atrial-LV pacing (Ap-LVp) at various AV-delays.
  • Reconstruction of vectorcardiogram (VCG) and EGMV from ECG and EGM data, extracting maximum QRS amplitude (QRSampl). Conventional Ap-RV determination methods (Ap-RVvis, Ap-RVaCRT, Ap-QRSonset) were used for comparison.

Main Results:

  • The longest AV-delay yielding an unaltered QRSampl in EGMV and VCG corresponded to the visually determined optimal delay (Ap-RVvis).
  • Ap-QRSonset and Ap-RVaCRT delays were found to be larger than the optimal delay identified by EGMV/VCG and visual assessment.
  • Ap-LVp-induced increases in LV dP/dtmax were significantly greater with AV-delays determined by EGMV/VCG and Ap-RVvis compared to Ap-QRSonset and Ap-RVaCRT.

Conclusions:

  • Electrogram-based vectorloop (EGMV) QRSampl analysis provides a reliable method for determining optimal, individualized AV-delay settings for LV fusion pacing.
  • This EGMV-derived approach may enhance long-term CRT response by optimizing device settings.
  • The findings suggest EGMV analysis is a valuable tool for improving CRT programming and patient outcomes.