{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T01:25:58Z","timestamp":1760059558691,"version":"build-2065373602"},"reference-count":24,"publisher":"MDPI AG","issue":"13","license":[{"start":{"date-parts":[[2025,6,22]],"date-time":"2025-06-22T00:00:00Z","timestamp":1750550400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Although cardiac resynchronization therapy (CRT) plays an established role in the management of heart failure, a significant proportion of patients do not respond despite appropriate candidate selection. The optimization of CRT pacing is one strategy to enhance response. Fusion pacing algorithms aim to synchronize intrinsic right ventricular (RV) conduction with paced left ventricular (LV) activation, resulting in a more physiological ventricular depolarization pattern. This approach may improve electrical synchrony and enhance left ventricular contraction compared to conventional simultaneous biventricular pacing. The aim of this study was to compare the acute, beat-to-beat effects of standard biventricular pacing versus fusion pacing on myocardial function, using both conventional and speckle-tracking echocardiography in heart failure patients with left bundle branch block (LBBB). Methods: In total, 27 heart failure patients (21 men and 6 women) with reduced ejection fraction (EF &lt; 35%), left bundle branch block (QRS &gt; 150 ms), and newly implanted CRT-D systems (Abbott) underwent echocardiographic assessment immediately after device implantation. Echocardiographic parameters\u2014including left atrial strain, left ventricular strain, TAPSE, mitral and tricuspid valve function, and cardiac output\u2014were measured at 5 min intervals under three different pacing conditions: pacing off, simultaneous biventricular pacing, and fusion pacing using Abbott\u2019s SyncAV\u00ae algorithm. Results: In our study, CRT led to a significant shortening of the QRS duration from 169 \u00b1 19 ms at baseline to 131 \u00b1 17 ms with standard biventricular pacing, and further to 118 \u00b1 16 ms with fusion pacing (p &lt; 0.05). Despite the electrical improvement, no significant changes were observed in global longitudinal strain (GLS: \u22129.15 vs. \u22129.39 vs. \u22129.13; p = NS), left ventricular stroke volume (67.5 mL vs. 68.4 mL vs. 68.5 mL; p = NS), or left atrial parameters including strain, area, and ejection fraction. However, fusion pacing was associated with more homogeneous segmental strain patterns, improved aortic valve closure time, and enhanced right ventricular function as reflected by tissue Doppler-derived S\u2019. Conclusions: Immediate QRS narrowing observed in CRT patients\u2014particularly with fusion pacing optimization\u2014is associated with a more homogeneous pattern of left ventricular contractility and improvements in selected measures of mechanical synchrony. However, these acute electrical changes do not translate into immediate improvements in stroke volume, global LV strain, or left atrial function. Longer-term follow-up is needed to determine whether the electrical benefits of CRT, especially with fusion pacing, lead to meaningful hemodynamic improvements.<\/jats:p>","DOI":"10.3390\/jcm14134433","type":"journal-article","created":{"date-parts":[[2025,6,23]],"date-time":"2025-06-23T07:42:34Z","timestamp":1750664554000},"page":"4433","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Acute Effects of Fusion Pacing Versus Standard CRT on Myocardial Function in Heart Failure Patients with LBBB"],"prefix":"10.3390","volume":"14","author":[{"given":"Micha\u0142","family":"Kucio","sequence":"first","affiliation":[{"name":"Division of Cardiology, Upper Silesian Medical Center, 40-635 Katowice, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3140-1806","authenticated-orcid":false,"given":"Andrzej","family":"Ku\u0142ach","sequence":"additional","affiliation":[{"name":"Department of Cardiology, School of Health Sciences in Katowice, Medical University of Silesia, 40-752 Katowice, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1149-7457","authenticated-orcid":false,"given":"Tomasz","family":"Skowerski","sequence":"additional","affiliation":[{"name":"Department of Cardiology, School of Health Sciences in Katowice, Medical University of Silesia, 40-752 Katowice, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7981-5250","authenticated-orcid":false,"given":"Mariusz","family":"Ba\u0142ys","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Upper Silesian Medical Center, 40-635 Katowice, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mariusz","family":"Skowerski","sequence":"additional","affiliation":[{"name":"Department of Cardiology, School of Health Sciences in Katowice, Medical University of Silesia, 40-752 Katowice, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Grzegorz","family":"Smolka","sequence":"additional","affiliation":[{"name":"Department of Cardiology, School of Health Sciences in Katowice, Medical University of Silesia, 40-752 Katowice, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,6,22]]},"reference":[{"key":"ref_1","first-page":"1651","article-title":"2021 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy: Developed by Task Force on Cardiac pacing and cardiac resychronization therapy of the Europian Society of Cardiology (ESC) with the special contribution of the European Heart Rhythm Association (EHRA)","volume":"43","author":"Glikson","year":"2022","journal-title":"Eur. 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