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Related Experiment Video

Updated: Jan 22, 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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Atrioventricular Delay Optimization in His-Optimized Cardiac Resynchronization Therapy: A Case Report.

Minh Nguyen Quang1, Dung Kieu Ngoc1, Son Nguyen Khac Le1

  • 1Arrhythmology Department Cho Ray Hospital Ho Chi Minh City Vietnam.

Clinical Case Reports
|January 21, 2026
PubMed
Summary

His bundle pacing (HBP) with optimized atrioventricular (AV) delay, termed His-optimized CRT (HOT-CRT), improved hemodynamic function and QRS duration in a heart failure patient. This approach enhances outcomes for those unresponsive to conventional CRT.

Keywords:
AV delay optimizationHis bundle pacingHis‐optimized CRTcardiac resynchronization therapyconduction system pacing

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Area of Science:

  • Cardiology
  • Electrophysiology
  • Medical Devices

Background:

  • His bundle pacing (HBP) is a physiologic pacing strategy that preserves ventricular synchrony.
  • Optimizing atrioventricular (AV) delay is crucial for hemodynamic efficiency in conduction system pacing.
  • Conventional cardiac resynchronization therapy (CRT) can be suboptimal in some heart failure patients.

Purpose of the Study:

  • To report a case of His-optimized CRT (HOT-CRT) in a patient with dilated cardiomyopathy and severe heart failure.
  • To demonstrate the impact of AV delay optimization on hemodynamic function and QRS duration.
  • To highlight the potential benefits of HOT-CRT in non-responders to conventional CRT.

Main Methods:

  • A patient with severe heart failure and non-responsive biventricular pacing underwent His bundle lead repositioning.
  • His bundle pacing (HBP) was combined with His-optimized CRT (HOT-CRT).
  • Atrioventricular (AV) delay optimization was performed post-procedure.

Main Results:

  • Following HOT-CRT and AV delay optimization, QRS duration narrowed from 185 ms to 120 ms.
  • The patient showed improved hemodynamic function and clinical stability at 15-month follow-up.
  • Ejection fraction improved from 16% to 25%, with no recurrence of ventricular tachycardia.

Conclusions:

  • HOT-CRT, combined with AV delay optimization, offers a valuable alternative for heart failure patients unresponsive to conventional CRT.
  • Individualized AV delay adjustment is critical for maximizing therapeutic outcomes in conduction system pacing.
  • Attention to QRS morphology and duration aids in identifying suitable candidates for personalized AV programming.