New Pacing Mode Improves Efficiency of CRT—Advanced Experience in Combining Biventricular Pacing with Atrioventricular Node Conduction—

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Objectives: Maintaining the atrioventricular node (AVN) conduction may improve CRT response. We evaluated the impact of biventricular (biv-) with AVN preference (AVNP) pacing on patients with CHF after CRT. Methods: AVNP pacing was performed under ECG monitoring, titrating AV delay until the ventricles were activated by both pacemaker and AVN, the narrowest QRS complex appeared. Patients planned for CRT with sinus rhythm and normal AV conduction were randomized to either traditional biv-pacing or AVNP pacing mode for 1 month, then crossed to another mode. Echocardiographic optimization was performed in patients in biv-pacing mode. Symptom, quality of life (QoL), ECG, echocardiography and events were compared between 2 modes. Results: From Jan to Dec 2009, 44 patients (34 male, mean aged 62.11±9.03) were recruited. Patients in AVNP mode had shorter QRSd (118.35±21.59 vs. 146.35±5.31 ms, P<0.0001); larger LVFS (17.41±5.9 vs. 15.66±4.90, P=0.019) and LVEF (35.50±9.72 vs. 32.68±9.74, P=0.048); higher 6MWT (372.51±80.88 m vs. 328.66±108.89 m, P=0.0001) and MLHFQ scores (12.48±6.56 vs. 18.16±12.25, P=0.0001) compared to biv-pacing mode. Conclusions: Patients experienced more benefit in symptom, cardiac function and QoL under AVNP pacing mode compared to biv-pacing mode. For patients with sinus rhythm and normal AV conduction who did not response well to CRT, the new program mode may help in improving efficiency and response.