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Background  Atrioventricular (AV) delay could affect AV and ventricular synchrony in cardiac resynchronization therapy (CRT). Strategies to optimize AV delay according to optimal AV synchrony (AV opt-AV ) or ventricular synchrony (AV opt-V ) would potentially be discordant. This study aimed to explore a new AV delay optimization algorithm guided by electrograms to obtain the maximum integrative effects of AV and ventricular resynchronization (opt-AV).    Methods  Forty-nine patients with CRT were enrolled. AV opt-AV  was measured through the Ritter method. AV opt-V  was obtained by yielding the narrowest QRS. The opt-AV was considered to be AV opt-AV  or AV opt-V  when their difference was < 20 ms, and to be the AV delay with the maximal aortic velocity–time integral between AV opt-AV  and AV opt-V  when their difference was > 20 ms.    Results  The results showed that sensing/pacing AV opt-AV  (SAV opt-AV /PAV opt-AV ) were correlated with atrial activation time (P end-As /P end-Ap ) ( P  < 0.05). Sensing/pacing AV opt-V  (SAV opt-V /PAV opt-V ) was correlated with the intrinsic AV conduction time (As-Vs/Ap-Vs) ( P  < 0.01). The percentages of patients with more than 20 ms differences between SAV opt-AV /PAV opt-AV  and SAV opt-V /PAV opt-V  were 62.9% and 57.1%, respectively. Among them, opt-AV was linearly correlated with SAV opt-AV /PAV opt-AV  and SAV opt-V /PAV opt-V.  The sensing opt-AV (opt-SAV) = 0.1 × SAV opt-AV  + 0.4 × SAV opt-V  + 70 ms (R 2  = 0.665,  P  < 0.01) and the pacing opt-AV (opt-PAV) = 0.25 × PAV opt-AV  + 0.5 × PAV opt-V  + 30 ms (R 2  = 0.560,  P  < 0.01).    Conclusion  The SAV opt-AV /PAV opt-AV  and SAV opt-V /PAV opt-V  were correlated with the atrial activation time and the intrinsic AV conduction interval respectively. Almost half of the patients had a > 20 ms difference between SAV opt-AV /PAV opt-AV  and SAV opt-V /PAV opt-V . The opt-AV could be estimated based on electrogram parameters.

An electrographic AV optimization for the maximum integrative atrioventricular and ventricular resynchronization in CRT