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Related Experiment Video

Updated: Feb 14, 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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Programming Cardiac Resynchronization Therapy for Electrical Synchrony: Reaching Beyond Left Bundle Branch Block and

Niraj Varma1, David O'Donnell2, Mohammed Bassiouny3

  • 1Cleveland Clinic, Cleveland, OH varman@ccf.org.

Journal of the American Heart Association
|February 13, 2018
PubMed
Summary

Cardiac resynchronization therapy using the SyncAV algorithm optimizes biventricular pacing by tailoring atrioventricular delay to individual patient conduction. This patient-specific approach significantly narrows QRS duration, improving therapy effectiveness.

Keywords:
cardiac resynchronization therapyleft bundle branch blockoptimization

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Area of Science:

  • Cardiology
  • Biomedical Engineering
  • Electrophysiology

Background:

  • Cardiac resynchronization therapy (CRT) effectiveness is influenced by patient-specific conduction characteristics.
  • A universal programming strategy for CRT may be ineffective due to variations in PR interval, qLV, and LV-paced propagation.
  • A novel device-based algorithm, SyncAV, automatically adjusts paced atrioventricular delay based on intrinsic atrioventricular conduction.

Purpose of the Study:

  • To evaluate the impact of patient-specific conduction characteristics on QRS narrowing following CRT.
  • To assess the efficacy of a novel automatic algorithm (SyncAV) in optimizing CRT pacing.
  • To compare different pacing configurations for maximizing QRS duration reduction.

Main Methods:

  • Seventy-five patients with left bundle branch block and optimized LV lead position were studied.
  • Pacing configurations included nominal simultaneous biventricular (BiV) pacing, BiV+SyncAV with fixed or optimized offset, and LV-only pacing+SyncAV.
  • QRS duration reduction was compared across different pacing modes.

Main Results:

  • Nominal BiV pacing reduced QRS duration by 11.8%.
  • BiV+SyncAV with a 50 ms offset achieved a 17.8% reduction, while LV-only pacing+SyncAV resulted in a 15.6% reduction.
  • The SyncAV algorithm with an optimized offset (Mode III) yielded the shortest QRS duration (-23.9%, P<0.001) and prevented QRS prolongation in all patients.

Conclusions:

  • Patient-tailored BiV pacing adjusted to intrinsic atrioventricular timing using an automatic algorithm facilitates post-implant electrical optimization.
  • The SyncAV algorithm effectively optimizes CRT by adapting to individual patient conduction characteristics.
  • This approach leads to significant QRS narrowing, potentially enhancing CRT efficacy.