3/22/2023 0 Comments Ivcd placement![]() ![]() As such and with the AV node (AVN) having rich sympathetic innervation and decremental properties, which accounts for some portion of the RA–RV time, we had to identify the end of the AV nodal contribution and the beginning of the septal contribution. 19 As the right atrial (RA) sense to RV sense was determined and used for the SyncAV measurement programming for 256 cycles, the offset delay is based on this RA–RV time delay. ![]() Similar effects have been demonstrated in prior studies in which tailoring the programming of the AV negative offset was generally determined by observation and intentional fusing of the QRS morphology, thus decreasing its duration on ECG. 26Īlthough our study lacked a control group of MPP programming without fusion, the final QRSd values in our analysis were substantially lower than those reported in the IRON-MPP trial, even despite that the majority of programming in that study was tailored to the narrowest QRSd (115.31 vs. ![]() In our method, the potential deleterious effects of RV pacing are felt to be decreased as multiple wavefronts are initiated. The overall baseline QRSd of 153.31 ± 24.60 ms was decreased to 115.31 ± 16.31 ms after MFP programming (p 80%) pacing, when combined with native activation like in the AdaptResponse clinical trial, seemed more beneficial than traditional CRT which includes RV pacing. A total of 22 patients (19 men and three women) with similar baseline characteristics were compared (all values in mean ± standard deviation). QRSd was compared between before and after programming. EGM-based measurements to determine the QRS septal onset to right ventricular (RV) time (SRAT) and the left ventricular (LV) to RV pacing conduction time were collected and applied to a formula to facilitate MFP. Patients in sinus rhythm with an AV conduction time of less than 350 ms were included in this analysis and were further stratified by strictly defined left bundle branch block (sLBBB) or nonspecific intraventricular conduction delay (IVCD). We therefore developed and tested a method combining MPP-CRT and controlled septal contribution to create a multifuse pacing (MFP) technique, establishing four ventricular activation sites for CRT patients using measurements from intracardiac electrograms (EGMs) and incorporating an AV-delay shortening algorithm (SyncAV™ Abbott Laboratories, Chicago, IL, USA) to narrow the QRSd. An additional site of activation via intrinsic conduction of the septum may further contribute to CRT however, the incorporation of all strategies together has yet to be explored. Multipoint pacing (MPP) has also demonstrated benefit in this population. Adaptive atrioventricular (AV)-shortening algorithms have achieved QRS duration (QRSd) narrowing in traditional cardiac resynchronization therapy (CRT) patients. RAFFAELE CORBISIERO, MD, FACC, 1 ANDREW MATHEW, DO, 1 CAITLIN BICKERT, BSN, 1 and DAVID MULLER, RN 2ġ Deborah Heart & Lung Center, Browns Mills, NJ, USAĪBSTRACT. Multipoint Pacing with Fusion-optimized Cardiac Resynchronization Therapy: Using It All to Narrow QRS Duration ![]()
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