Chapter 7. Programming CRT Devices

  1. Kenneth A. Ellenbogen MD2 and
  2. Angelo Auricchio MD, PhD Director3
  1. Bengt Herweg MD,
  2. Arzu Ilercil MD and
  3. S. Serge Barold MD

Published Online: 26 FEB 2009

DOI: 10.1002/9781444303452.ch7

Pacing to Support the Failing Heart

Pacing to Support the Failing Heart

How to Cite

Herweg, B., Ilercil, A. and Barold, S. S. (2008) Programming CRT Devices, in Pacing to Support the Failing Heart (eds K. A. Ellenbogen and A. Auricchio), Wiley-Blackwell, Oxford, UK. doi: 10.1002/9781444303452.ch7

Editor Information

  1. 2

    Kontos Professor of Cardiology, Medical College of Virginia, Richmond, VA, USA

  2. 3

    Heart Failure Service, Fondazione Cardiocentro Ticino, Lugano, Switzerland

Author Information

  1. Arrhythmia Service and Division of Cardiology, Tampa General Hospital and University of South Florida, Tampa, FL, USA

Publication History

  1. Published Online: 26 FEB 2009
  2. Published Print: 5 DEC 2008

Book Series:

  1. The AHA Clinical Series

Book Series Editors:

  1. Elliott Antman

Series Editor Information

  1. Samuel A. Levine Cardiac Unit, Brigham and Women's Hospital, USA

ISBN Information

Print ISBN: 9781405175340

Online ISBN: 9781444303452



  • programming CRT devices;
  • cardiac resynchronization therapy (CRT) programming;
  • Twelve-lead electrocardiography;
  • QRS morphology during left ventricular pacing;
  • QRS morphology during biventricular pacing;
  • postventricular atrial refractory period (PVARP);
  • pre-empted Wenckebach upper-rate response;
  • anodal stimulation in biventricular pacemakers;
  • optimization of V–V timing using electrocardiogram


This chapter contains sections titled:

  • Key Points

  • General considerations

  • Twelve-lead electrocardiography

  • QRS morphology during right ventricular pacing

  • QRS morphology during left ventricular pacing from the coronary venous system

  • QRS morphology during biventricular pacing

  • Upper-rate response

  • Loss of resynchronization below the programmed upper rate and optimal programming of PVARP

  • Programming automatic unlocking of P waves from the PVARP

  • Programming the lower rate

  • Far-field, R-wave oversensing

  • Atrial fibrillation and atrial tachyarrhythmia

  • Programming of left ventricular pacing output

  • Phrenic nerve stimulation and electrical repositioning

  • Anodal stimulation in biventricular pacemakers

  • Triggered ventricular pacing

  • Verification of programmed settings by exercise testing

  • Programming the AV interval

  • The optimal AV relationship

  • Prolonged AV conduction and too-long AV delay

  • Short AV delay

  • Invasive and noninvasive methods of AV optimization

  • Echocardiography

  • Alternative AV optimization techniques apart from echocardiography

  • Semi-automatic optimization of the AV interval

  • Fusion with the spontaneously conducted QRS complex

  • Rate adaptation of the AV interval and exercise

  • Long-term evaluation of the AV delay

  • Intra-atrial and Inter-atrial conduction delay

  • Programming the inter-ventricular (V-V) interval

  • Impact of V-V interval programming on the effective AV delay: Differences between device manufacturers

  • Latency and delayed intraventricular, and interventricular conduction

  • Optimization of V-V timing using the electrocardiogram

  • References