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Optimizing Cardiac Resynchronization Therapy: AV Timing Strategies and Outcomes
Session:
Sessão de Posters 53 - Otimização de CRT em 2026
Speaker:
Sofia Esteves
Congress:
CPC 2026
Topic:
C. Arrhythmias and Device Therapy
Theme:
09. Device Therapy
Subtheme:
09.3 Cardiac Resynchronization Therapy
Session Type:
Posters Eletrónicos
FP Number:
---
Authors:
Sofia Esteves; João Cravo; Joana Brito; Susana Gonçalves; Ana Bernardes; Sara Couto Pereira; Pedro Silvério António; Nelson Cunha; Andreia Magalhães; Fausto Pinto; João de Sousa; Pedro Marques
Abstract
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><strong><span style="font-family:"Calibri",sans-serif">Introduction: </span></strong><span style="font-family:"Calibri",sans-serif">Optimizing atrioventricular (AV) timing is key to maximizing the hemodynamic benefits of cardiac resynchronization therapy (CRT). Although fixed AV delay programming is common, fusion pacing optimization algorithms (FPO) with the intrinsic rhythm may enhance ventricular filling and cardiac output. However, randomized prospective evidence comparing these strategies remains limited.</span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><strong><span style="font-family:"Calibri",sans-serif">Aim: </span></strong><span style="font-family:"Calibri",sans-serif">To compare the clinical effects of FPO algorithm versus fixed AV delay programming in CRT patients.</span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><strong><span style="font-family:"Calibri",sans-serif">Methods:</span></strong><span style="font-family:"Calibri",sans-serif"> This prospective, randomized, parallel-group study included consecutive CRT patients from August 2020 to March 2023 in a tertiary centre. After implantation, participants were randomized 1:1 to FPO or fixed AV delay. AV settings followed predefined protocols; all other programming adhered to guideline-directed CRT recommendations. Clinical evaluation, electrocardiographic (ECG) and echocardiography were performed at baseline and at 12 months. The primary endpoint was all-cause death or hospitalization. Secondary endpoints included changes in paced QRS duration, clinical and echocardiographic response rates and echocardiographic/ECG parameters change. Clinical response was defined as ≥10% NT-proBNP reduction or ≥1 NYHA class improvement. Echocardiographic response was defined as ≥15% LVESV reduction and ≥5% LVEF increase.</span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><strong><span style="font-family:"Calibri",sans-serif">Results: </span></strong><span style="font-family:"Calibri",sans-serif">We included 135 patients, 70 randomized to fixed AV delay (Fixed) and 65 to FPO algorithm. The baseline characteristics of the population were similar between the 2 groups, except for a higher baseline use of diuretics in the FPO group (<u>Table 1</u>).<strong> </strong>The QRS duration in pacing before randomization was not significantly different between 2 groups.<strong> </strong>After a follow up of 12 months, the primary endpoint occurred in 22 patients, 14 in the FPO group and 8 in the fixed group and this difference was not statistically significant- p value (Log Rank) 0.806- (<u>Graph 1</u>).<strong> </strong>Regarding the secondary endpoints,<strong> </strong>the mean QRS duration in pacing was significantly lower in the FPO group (median reduction of 15 ms in the FPO group vs 2 ms in fixed group, p value 0.02). Also,79% of the patients were echocardiographic responders and 80% were clinical responders in both group and this was not different between the 2 groups. The reverse LV remodelling by echocardiogram and intrinsic ECG changes between 2 groups were similar at 12 months, apart from the improvement in TAPSE, which was significantly higher in the FPO group (<u>Table 2</u>). </span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><strong><span style="font-family:"Calibri",sans-serif">Conclusions: </span></strong><span style="font-family:"Calibri",sans-serif">Despite QRS narrowing with the FPO algorithm, it offered no added benefit over a fixed AV delay at 12 months. High clinical and echocardiographic response rates in both groups suggest that the primary advantage derives from proper CRT itself rather than the specific AV-timing strategy</span></span></span></p>
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