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Related Experiment Video

Updated: Sep 29, 2025

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

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

Published on: December 11, 2017

Device-based Optimization of Cardiac Resynchronization-One Size Does Not Fit All.

Wasim Rashid¹, Asim Kichloo², Khalil Kanjwal³

¹Department of Cardiology, Sheri Kashmir Institute of Medical Sciences, Srinagar, India.

The Journal of Innovations in Cardiac Rhythm Management

|March 23, 2022

Summary

A biventricular intracardiac defibrillator (BIV-ICD) was evaluated in a patient with heart failure and right bundle branch block (RBBB). The BIV-ICD did not significantly narrow the QRS duration, indicating a potential programming or device issue.

Keywords:

Cardiac resynchronization therapy Sync-AV cardiomyopathy defibrillator right bundle branch block

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Area of Science:

Cardiology
Biomedical Engineering

Background:

A 72-year-old female with ischemic cardiomyopathy and NYHA class III heart failure was evaluated for a biventricular intracardiac defibrillator (BIV-ICD).
The patient presented with a low ejection fraction (20%-25%) despite optimal medical therapy and had underlying right bundle branch block (RBBB) with a QRS duration of 160 ms.

Observation:

A BIV-ICD was implanted and programmed with the Sync-AV algorithm.
Postoperative electrocardiography revealed persistent RBBB with minimal QRS narrowing, similar to baseline.

Findings:

The BIV-ICD did not effectively achieve cardiac resynchronization therapy (CRT) in this patient with RBBB.
This suggests potential challenges in optimizing BIV-ICD programming for CRT in patients with wide QRS complex and RBBB.

Implications:

Further investigation into the mechanism of failed QRS narrowing is warranted.
This case highlights the need for tailored troubleshooting and programming strategies for BIV-ICDs in complex heart failure patients.
Optimizing BIV-ICD therapy is crucial for improving outcomes in patients with heart failure and conduction abnormalities.