TY - JOUR
T1 - Acute hemodynamic effects of a novel algorithm for cardiac resynchronization therapy optimization
T2 - Results from the BIO|Adapt study
AU - Garcia-Fernandez, Francisco Javier
AU - Ando, Kenji
AU - Kato, Ritsushi
AU - Martínez, Juan Gabriel
AU - Berruezo, Antonio
AU - Jimenez, Javier
AU - Anneken, Lars
AU - Hironobe, Naoya
AU - Harada, Masahide
AU - Yagishita, Atsuhiko
AU - Osca-Asensi, Joaquin
AU - Mitkowski, Przemysław
AU - Hayashi, Hidemori
AU - Kishihara, Jun
AU - Pardo-Fresno, Mónica
AU - Ebrahim, Iftikhar
AU - Meyhöfer, Jürgen
AU - Salguero-Bodes, Rafael
AU - Marques, Pedro
AU - Moreno, Alicia
AU - Pinart, Mariona
AU - Bulava, Alan
N1 - Publisher Copyright:
© 2026 Heart Rhythm Society.
PY - 2026/4
Y1 - 2026/4
N2 - Background A considerable proportion of patients with heart failure with reduced left ventricular ejection fraction (LVEF) and prolonged QRS duration fail to respond adequately to cardiac resynchronization therapy (CRT). Suboptimal atrioventricular (AV) delay programming is a key factor leading to diminished response. Objective This study aimed to acutely correlate aortic velocity time integral, LVEF, and QRS duration with 3 programming strategies in the postimplantation setting: AV delay automatically set by a novel CRT AutoAdapt algorithm, AV delay optimized by echocardiography, and standard (“in-box”) programming. Methods Under normal intrinsic AV conduction (<250 ms after atrial pacing), the CRT AutoAdapt algorithm automatically switches to left ventricular-only pacing and adapts the AV delay to 50%, 70% (default), or 90% of intrinsic AV conduction. In our study, 163 CRT-defibrillator recipients (mean age 69.2 ± 9.2 years; 32% female; LVEF 27.7% ± 6.6%; 76% with left bundle branch block) underwent echocardiographic and electrocardiographic assessments at prehospital discharge. Results With the default 70% AV adaptation, the CRT AutoAdapt automatically set a similar AV delay (117.1 ± 23.9 ms) compared with echocardiography-guided optimization (118.3 ± 30.2 ms; P = .94). Strong concordance was observed between the algorithm and echocardiography-guided optimization for aortic velocity time integral (concordance correlation coefficient 0.96) and LVEF (0.93). Both optimization methods significantly outperformed standard AV programming for LVEF improvement ( P < .001) and QRS-width reduction ( P < .01), with no significant differences between optimization approaches. Conclusion Acute hemodynamic effects of CRT AutoAdapt and echocardiography-guided AV-delay optimization were similar, with equivalent cardiac performance. This device-based approach offers the potential advantage of continuous adaptation to changing physiological conditions without requiring resource-intensive in-office optimization procedures.
AB - Background A considerable proportion of patients with heart failure with reduced left ventricular ejection fraction (LVEF) and prolonged QRS duration fail to respond adequately to cardiac resynchronization therapy (CRT). Suboptimal atrioventricular (AV) delay programming is a key factor leading to diminished response. Objective This study aimed to acutely correlate aortic velocity time integral, LVEF, and QRS duration with 3 programming strategies in the postimplantation setting: AV delay automatically set by a novel CRT AutoAdapt algorithm, AV delay optimized by echocardiography, and standard (“in-box”) programming. Methods Under normal intrinsic AV conduction (<250 ms after atrial pacing), the CRT AutoAdapt algorithm automatically switches to left ventricular-only pacing and adapts the AV delay to 50%, 70% (default), or 90% of intrinsic AV conduction. In our study, 163 CRT-defibrillator recipients (mean age 69.2 ± 9.2 years; 32% female; LVEF 27.7% ± 6.6%; 76% with left bundle branch block) underwent echocardiographic and electrocardiographic assessments at prehospital discharge. Results With the default 70% AV adaptation, the CRT AutoAdapt automatically set a similar AV delay (117.1 ± 23.9 ms) compared with echocardiography-guided optimization (118.3 ± 30.2 ms; P = .94). Strong concordance was observed between the algorithm and echocardiography-guided optimization for aortic velocity time integral (concordance correlation coefficient 0.96) and LVEF (0.93). Both optimization methods significantly outperformed standard AV programming for LVEF improvement ( P < .001) and QRS-width reduction ( P < .01), with no significant differences between optimization approaches. Conclusion Acute hemodynamic effects of CRT AutoAdapt and echocardiography-guided AV-delay optimization were similar, with equivalent cardiac performance. This device-based approach offers the potential advantage of continuous adaptation to changing physiological conditions without requiring resource-intensive in-office optimization procedures.
KW - AV optimization
KW - Aortic velocity time integral
KW - Cardiac resynchronization therapy
KW - Heart failure
KW - LV pacing
UR - https://www.scopus.com/pages/publications/105031597812
UR - https://www.scopus.com/pages/publications/105031597812#tab=citedBy
U2 - 10.1016/j.hroo.2026.01.030
DO - 10.1016/j.hroo.2026.01.030
M3 - Article
AN - SCOPUS:105031597812
SN - 2666-5018
VL - 7
SP - 686
EP - 694
JO - Heart Rhythm O2
JF - Heart Rhythm O2
IS - 4
ER -