Dynamic programming of atrioventricular delay improves electrical synchrony in a multicenter cardiac resynchronization therapy study

Thibault, Bernard; Ritter, Philippe; Bode, Kerstin; Calò, Leonardo; Mondésert, Blandine; Mangual, Jan; Badie, Nima; McSpadden, Luke C.; Pappone, Carlo; Varma, Niraj

doi:10.1016/j.hrthm.2019.01.020

Cited by 43 publications

(39 citation statements)

References 16 publications

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“…As is mentioned in previous studies, SyncAV CRT allows offset programmability to achieve the greatest QRSd reduction for each patient . Such an ECG‐guided optimization (mode III BiV pacing) resulted in better mechanical synchrony and acute hemodynamic improvement in the present study, with even smaller Ts‐SD and higher aVTI than Mode II BiV pacing.…”

Section: Discussionsupporting

confidence: 73%

“…Unlike aCRT algorithm, its AV delay (AVD) is programmed 50 ms shorter than the automatically measured intrinsic AV interval. Such an “offset” of 50 ms is programmable, allowing for paced BiV wavefronts to fuse with intrinsic conduction (ie, a triple wavefront fusion), instead of LV‐only pacing during normal AV conduction . Hence, such kind of automatic device‐based algorithm could be implemented by patient‐specific programming, rather than any default settings.…”

Section: Introductionmentioning

confidence: 99%

“…Hence, such kind of automatic device‐based algorithm could be implemented by patient‐specific programming, rather than any default settings. Previous studies have demonstrated that SyncAV algorithm improved acute electrical synchrony beyond conventional CRT, which was further enhanced by patient‐tailored SyncAV offset optimization . Nevertheless, whether this patient‐specific BiV pacing adjusted to intrinsic AV timing could yield mechanical benefits remains uncertain.…”

Section: Introductionmentioning

confidence: 99%

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Patient‐tailored SyncAV algorithm: A novel strategy to improve synchrony and acute hemodynamic response in heart failure patients treated by cardiac resynchronization therapy

Wang

Liang

Chen

et al. 2019

Cardiovasc electrophysiol

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Introduction: Several automatic algorithms have developed to optimize the timing cycle setting in cardiac resynchronization therapy (CRT). The present study aims to investigate whether the novel device-based SyncAV algorithm could elicit better synchrony and acute hemodynamic response.Methods and Results: Thirty five patients undergoing CRT implantation were prospectively studied. The device was programmed to three biventricular (BiV) pacing modes sequentially after the procedure: QuickOpt algorithm (mode I), SyncAV algorithm with default 50 ms offset (mode II), and SyncAV algorithm with optimized offset minimizing QRS duration (QRSd) (mode III). After each setting, electrocardiographic and echocardiographic data were collected. As a result, QRSd was reduced from 172.8 ± 17.9 ms during intrinsic conduction to 153.1 ± 15.9 ms in mode I, further narrowed to 140.5 ± 16.7 ms in mode II, and reached shortest (134.8 ± 16.1 ms) in mode III (P < .01 for all). Besides, significantly shorter QT intervals were observed in mode I (453.2 ± 45.5 ms), mode II (443.9 ± 34.2 ms) and mode III (444.1 ± 28.7 ms), compared with native condition (472.5 ± 51.2 ms) (P < .01). All three BiV modes exhibited comparable T p T e interval and T p T e /QT ratio (P > .05). Mode I presented significantly higher aortic velocity time integral than intrinsic conduction (21.0 ± 6.4 cm vs 18.4 ± 5.5 cm; P < .01), which was even higher in mode II (22.0 ± 6.5 cm) and mode III (23.7 ± 6.5 cm). All three BiV modes significantly reduced standard deviation of time to peak contraction of 12-LV segments (Ts-SD) (Mode I: 55.2 ± 16.5 ms, Mode II: 50.2 ± 14.7 ms, Mode III: 45.4 ± 14.4 ms) compared with intrinsic conduction (66.3 ± 18.4 ms) (P < .01), with Mode III demonstrating the smallest (P < .01).

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Section: Discussionsupporting

confidence: 73%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Patient‐tailored SyncAV algorithm: A novel strategy to improve synchrony and acute hemodynamic response in heart failure patients treated by cardiac resynchronization therapy

Wang

Liang

Chen

et al. 2019

Cardiovasc electrophysiol

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“…The SyncAV algorithm has been described. 13,14 In brief, the SyncAV algorithm periodically extends the AV delay. When intrinsic ventricular events are sensed, the device device clinic visits.…”

Section: Device Programmingmentioning

confidence: 99%

“…Recent published data reported a significant QRS narrowing with programming of SyncAV in existing CRT devices as determined acutely by 12lead ECG, but did not report longer-term outcomes. 13,14 The pacing configuration that achieved the narrowest QRS with SyncAV was biventricular pacing with SyncAV and an optimized offset. 10,14 Whether reprogramming of CRT to increase electrical synchrony translates into echocardiographic and functional status improvement remains unclear.…”

mentioning

confidence: 99%

Optimization of Chronic Cardiac Resynchronization Therapy Using Fusion Pacing Algorithm Improves Echocardiographic Response

et al. 2020

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Background: Whether reprogramming of cardiac resynchronization therapy (CRT) to increase electrical synchrony translates into echocardiographic improvement remains unclear. SyncAV is an algorithm that allows fusion of intrinsic conduction with biventricular pacing. We aimed to assess whether reprogramming chronically implanted CRT devices with SyncAV is associated with improved echocardiographic parameters. Methods: Patients at a quaternary center with previously implanted CRT devices with a programmable SyncAV algorithm underwent routine electrocardiography-based SyncAV optimization during regular CJC Open 2 (2020) 62e70

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2023 HRS/APHRS/LAHRS guideline on cardiac physiologic pacing for the avoidance and mitigation of heart failure

Chung

Patton

Lau³

et al. 2023

Journal of Arrhythmia

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Cardiac physiologic pacing (CPP), encompassing cardiac resynchronization therapy (CRT) and conduction system pacing (CSP), has emerged as a pacing therapy strategy that may mitigate or prevent the development of heart failure (HF) in patients with ventricular dyssynchrony or pacing‐induced cardiomyopathy. This clinical practice guideline is intended to provide guidance on indications for CRT for HF therapy and CPP in patients with pacemaker indications or HF, patient selection, pre‐procedure evaluation and preparation, implant procedure management, follow‐up evaluation and optimization of CPP response, and use in pediatric populations. Gaps in knowledge, pointing to new directions for future research, are also identified.

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Dynamic programming of atrioventricular delay improves electrical synchrony in a multicenter cardiac resynchronization therapy study

Cited by 43 publications

References 16 publications

Patient‐tailored SyncAV algorithm: A novel strategy to improve synchrony and acute hemodynamic response in heart failure patients treated by cardiac resynchronization therapy

Patient‐tailored SyncAV algorithm: A novel strategy to improve synchrony and acute hemodynamic response in heart failure patients treated by cardiac resynchronization therapy

Optimization of Chronic Cardiac Resynchronization Therapy Using Fusion Pacing Algorithm Improves Echocardiographic Response

2023 HRS/APHRS/LAHRS guideline on cardiac physiologic pacing for the avoidance and mitigation of heart failure

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