{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T11:40:30Z","timestamp":1773056430505,"version":"3.50.1"},"reference-count":35,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2017,6,16]],"date-time":"2017-06-16T00:00:00Z","timestamp":1497571200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pacing Clinical Electrophis"],"published-print":{"date-parts":[[2017,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Previous reports suggest that biventricular pacing (BiVp) fused with intrinsic conduction (BiVp\u2010fusion, triple wavefront fusion) is associated with improved resynchronization compared to pure\u2010BiVp in cardiac resynchronization therapy (CRT). This study aimed to assess the association between acute hemodynamic benefit of CRT and signs of BiVp\u2010fusion by using a novel electrogram (EGM)\u2010based method.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>In 17 patients undergoing CRT implantation, 28 combinations of atrioventricular (AV) and interventricular (VV) delays were applied while invasively measuring acute hemodynamic response based on maximum rate of left ventricular (LV) pressure rise (LV dP\/dt<jats:sub>max<\/jats:sub>) to assess optimal BiVp settings. BiVp\u2010fusion was noted if farfield signal (caused by first intrinsic ventricular depolarization) was seen prior to right ventricular (RV) pacing (RVp) artifact on integrated bipolar RV EGM, or QRS morphology changed compared to pure\u2010BiVp (short AV\u2010delay) as seen on electrocardiogram (ECG).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Mean optimal RVp timing was at 98 \u00b1 17% of intrinsic right atrial (RA)\u2010RV<jats:sub>farfield<\/jats:sub> (interval from right atrial pace or sense to RV farfield signal) interval, while preactivating the LV at 50 \u00b1 11% of RA\u2010RV<jats:sub>sense<\/jats:sub> (interval from right atrial pace or sense to RV sense interval) interval. BiVp\u2010fusion was noted in 16 of 17 (94%) patients on ECG during optimal BiVp. Eight of these patients showed intrinsic farfield signal prior to RVp artifact on RV EGM. In the remaining eight, the RVp was paced just within the RA\u2010RV<jats:sub>farfield<\/jats:sub> interval with a mean of 25 \u00b1 14 ms prior to the onset; therefore, the intrinsic farfield was masked.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Optimal hemodynamic BiVp facilitates triple wavefront fusion, by pacing the RV around the onset of intrinsic farfield signal on RV EGM, while preactivating the LV. Aiming at BiVp\u2010fusion could be a target for noninvasive EGM\u2010based CRT device setting optimization.<\/jats:p><\/jats:sec>","DOI":"10.1111\/pace.13118","type":"journal-article","created":{"date-parts":[[2017,5,24]],"date-time":"2017-05-24T00:33:41Z","timestamp":1495586021000},"page":"873-882","source":"Crossref","is-referenced-by-count":26,"title":["The concept of triple wavefront fusion during biventricular pacing: Using the EGM to produce the best acute hemodynamic improvement in CRT"],"prefix":"10.1111","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9730-6564","authenticated-orcid":false,"given":"Iris A.H.","family":"ter Horst","sequence":"first","affiliation":[{"name":"Department of Cardiology University Medical Center Utrecht  Utrecht The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Margot D.","family":"Bogaard","sequence":"additional","affiliation":[{"name":"Department of Cardiology University Medical Center Utrecht  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