Comparison Between Conventional Biventricular Pacing CRT and LV Pacing Only CRT Using Automatic Device-Based Optimization Algorithms

Background: In the treatment of heart failure (HF), cardiac resynchronization therapy (CRT) has become essential due to the related decreases in mortality and morbidity in eligible patients. Aim and objectives: Using the new automatic device-based optimization methods, we will compare the effectiveness of CRT with that of LV-only pacing and the traditional optimization approach. Patients and methods: This prospective comparative study was conducted on 34 patients with CRT at Al-Hussein University Hospital, Department of Cardiology, Faculty of Medicine, Al-Azhar University in Cairo from October 2021 to November 2023. Results: In the Medtronic group, there is a Statistically significant (p-value=0.02) decrease of NYHA Class, High statistical significant (p-value<0.001) increase in 6MWT, Statistically significant (p-value=0.002) increase in EF, and High statistical significant (p-value<0.001)decrease in ESV with LVP mode when compared with BiVP group. In the Abbot group, there is a Statistically significant (p-value=0.03) decrease in NYHA class, a High statistically significant(p-value<0.001) increase in 6MWT, High statistically significant (p-value<0.001)increase in EF, and Statistically significant (p-value=0.001) decrease in ESV with LVP when compared with BiVP group. Conclusion: Compared to traditional BiVP, the efficacy of CRT was greatly improved by two new device-based algorithms, Adaptive CRT and SyncAV. These algorithms provided left ventricular pacing fused with intrinsic conduction to a subset of patients with intact AV conduction. In addition, the SyncAV offset could be fine-tuned for each patient depending on their electrocardiogram (ECG), which improved the acute narrowing of QRS width.