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Cardiac Resynchronization Therapy and AV Optimization: A Hemodynamic Evaluation with Non-Invasive Techniques

Year 2025, Issue: Early Access
https://doi.org/10.18678/dtfd.1661965

Abstract

Aim: This study aimed to evaluate the impact of atrioventricular (AV) optimization of biventricular pacemakers on cardiac hemodynamic parameters, particularly mitral inflow and aortic valve velocity-time integral (VTI), using impedance cardiography (ICG) and echocardiography in patients with symptomatic systolic heart failure and left bundle branch block unresponsive to cardiac resynchronization therapy.
Material and Methods: The study included 20 patients, 10 (50%) males and 10 (50%) females, aged between 18 and 80 years, who had undergone biventricular pacemaker implantation and did not have aortic stenosis, decompensated heart failure, or echocardiographically optimized AV interval measurements. Hemodynamic values were calculated following ICG measurements.
Results: The mean AV delay time did not change after AV optimization (p=0.685). However, optimization led to a statistically significant increase in mitral inflow VTI and aortic valve VTI (both p<0.001). No significant post-optimization variations were observed in hemodynamic parameters obtained by ICG compared to baseline measurements. There was a statistically significant decrease in heart rate when compared to the pre-optimization values (p=0.003).
Conclusion: This study identified a significant enhancement in echocardiographic parameters attributable to AV optimization. The results obtained with AV optimization were consistent with those of large-scale randomized studies. However, further comprehensive studies are needed to assess the individual patient responses and long-term outcomes.

References

  • Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM, et al. AHA/ACC/HFSA guideline for the management of heart failure: a report of the American college of cardiology/American heart association joint committee on clinical practice guidelines. Circulation. 2022;145(18):e895-1032.
  • Butter C, Seifert M, Georgi C, Iliodromitis K, Bogossian H. Cardiac resynchronization therapy: current guidelines and recent advances beyond drug treatment. Curr Pharm Des. 2023;29(20):1557-63.
  • McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M, et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2021;42(36):3599-726.
  • Santoro A, Landra F, Marallo C, Taddeucci S, Sisti N, Pica A, et al. Biventricular or conduction system pacing for cardiac resynchronization therapy: a strategy for cardiac resynchronization based on a hybrid approach. J Cardiovasc Dev Dis. 2023;10(4):169.
  • Bozkurt B, Coats AJS, Tsutsui H, Abdelhamid CM, Adamopoulos S, Albert N, et al. Universal definition and classification of heart failure: a report of the Heart Failure Society of America, Heart Failure Association of the European Society of Cardiology, Japanese Heart Failure Society and Writing Committee of the Universal Definition of Heart Failure. Eur J Heart Fail. 2021;23(3):352-80.
  • Bristow MR, Saxon LA, Boehmer J, Krueger S, Kass DA, De Marco T, et al. Cardiac-resynchronization therapy with or without an implantable defibrillator in advanced chronic heart failure. N Engl J Med. 2004;350(21):2140-50.
  • Moss AJ, Hall WJ, Cannom DS, Klein H, Brown MW, Daubert JP, et al. Cardiac-resynchronization therapy for the prevention of heart-failure events. N Engl J Med. 2009;361(14):1329-38.
  • Tang AS, Wells GA, Talajic M, Arnold MO, Sheldon R, Connolly S, et al. Cardiac resynchronization therapy for mild-to-moderate heart failure. N Engl J Med. 2010;363(25):2385-95.
  • Cleland JG, Daubert JC, Erdmann E, Freemantle N, Gras D, Kappenberger L, et al. The effect of cardiac resynchronization on morbidity and mortality in heart failure. N Engl J Med. 2005;352(15):1539-49.
  • Dickstein K, Vardas PE, Auricchio A, Daubert JC, Linde C, McMurray J, et al. 2010 focused update of ESC Guidelines on device therapy in heart failure. Eur J Heart Fail. 2010;12(11):1143-53.
  • Beshai JF, Grimm RA, Nagueh SF, Baker JH 2nd, Beau SL, Greenberg SM, et al. Cardiac-resynchronization therapy in heart failure with narrow QRS complexes. N Engl J Med. 2007;357(24):2461-71.
  • Chung ES, Leon AR, Tavazzi L, Sun JP, Nihoyannopoulos P, Merlino J, et al. Results of the Predictors of Response to CRT (PROSPECT) trial. Circulation. 2008;117(20):2608-16.
  • Qamruddin S, Rafie R, Tasneem Z. Discordant left and right ventricular optimal atrioventricular and interventricular delays during biventricular pacemaker optimization. Echocardiography. 2013;30(7):751-8.
  • van Bommel RJ, Bax JJ, Abraham WT, Chung ES, Pires LA, Tavazzi L, et al. Characteristics of heart failure patients associated with good and poor response to cardiac resynchronization therapy: a PROSPECT (Predictors of Response to CRT) sub-analysis. Eur Heart J. 2009;30(20):2470-7.
  • Dickstein K, Cohen-Solal A, Filippatos G, McMurray JJ, Ponikowski P, Poole-Wilson PA, et al. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: the Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2008 of the European Society of Cardiology. Eur Heart J. 2008;29(19):2388-442.
  • Cohen J. Statistical power analysis for the behavioral sciences. 2nd ed. Hillsdale, NJ: Lawrence Erlbaum Associates; 1988.
  • Akkoca A, Büyükakilli B, Balli E, Gültekin B, Özbay E, Oruç Demirbağ H, et al. Protective effect of MitoTEMPO against cardiac dysfunction caused by ischemia-reperfusion: MCAO stroke model study. Int J Neurosci. 2024;134(12):1582-93.
  • De Pasquale MJ, Fossa AA. Use of bioimpedance for measuring cardiac output in the conscious dog. Drug Dev Res. 1996;38(2):105-13.
  • Bernstein DP. A new stroke volume equation for thoracic electrical bioimpedance: theory and rationale. Crit Care Med. 1986;14(10):904-9.
  • Turkseven CH, Pekoglu E, Buyukakilli B. Hemodynamic effects of epinephrine in rats: evaluation by impedance cardiography. Bratisl Lek Listy. 2017;118(10):613-7.
  • Mosteller RD. Simplified calculation of body-surface area. N Engl J Med. 1987;317(17):1098.
  • Moss AJ, Hall WJ, Cannom DS, Klein H, Brown MW, Daubert JP, et al. Cardiac-resynchronization therapy for the prevention of heart-failure events. N Engl J Med. 2009;361(14):1329-38.
  • Daubert C, Behar N, Martins RP, Mabo P, Leclercq C. Avoiding non-responders to cardiac resynchronization therapy: a practical guide. Eur Heart J. 2017;38(19):1463-72.
  • Varma N, Boehmer J, Bhargava K, Yoo D, Leonelli F, Costanzo M, et al. Evaluation, management, and outcomes of patients poorly responsive to cardiac resynchronization device therapy. J Am Coll Cardiol. 2019;74(21):2588-603.
  • Moulin T, Hamon D, Djouadi K, D'Humières T, Elbaz N, Boukantar M, et al. Impact of cardiac resynchronization therapy optimization inside a heart failure programme: a real-world experience. ESC Heart Fail. 2022;9(5):3101-12.
  • Glikson M, Nielsen JC, Kronborg MB, Michowitz Y, Auricchio A, Barbash IM, et al. 2021 ESC guidelines on cardiac pacing and cardiac resynchronization therapy. Eur Heart J. 2021;42(35):3427-520.
  • Auricchio A, Prinzen FW. Non-responders to cardiac resynchronization therapy: The magnitude of the problem and the issues. Circ J. 2011;75(3):521-7.
  • Linde C. CRT-P or CRT-D in heart failure patients: The RESET-CRT project-a prelude to the randomized controlled RESET-CRT study. Eur Heart J. 2022;43(27):2600-2.
  • Naqvi TZ, Rafique AM, Peter CT. Echo-driven V-V optimization determines clinical improvement in non responders to cardiac resynchronization treatment. Cardiovasc Ultrasound. 2006;4:39.
  • Oğuz E. Cardiac resynchronization therapy. In: Oto A, Aytemir K, Çeliker A, Köse S, Özin B, editors. Permanent pacemakers and implantable defibrillators. Ankara: Hacettepe Üniversitesi Hastaneleri Basım Evleri; 2006. p.191-200. Turkish.
  • Borek PP. Cardiac resynchronization therapy. In: Griffin BP, Topol EJ, editors. Manual of cardiovascular medicine. Atalar E, trans. editor. 3rd ed. Ankara: Güneş Tıp Kitabevi; 2010. p.734-42. Turkish.
  • Dupuis M, Noel-Savina E, Prévot G, Tétu L, Pillard F, Rivière D, et al. Determination of cardiac output in pulmonary hypertension using impedance cardiography. Respiration. 2018;96(6):500-6.
  • Guha A, Arora D, Mehta Y. Comparative study of cardiac output measurement by regional impedance cardiography and thermodilution method in patients undergoing off pump coronary artery bypass graft surgery. Ann Card Anaesth. 2022;25(3):335-42.
  • Kim GE, Kim SY, Kim SJ, Yun SY, Jung HH, Kang YS, et al. Accuracy and efficacy of impedance cardiography as a non-invasive cardiac function monitor. Yonsei Med J. 2019;60(8):735-41.
  • Ellenbogen KA, Gold MR, Meyer TE, Fernndez Lozano I, Mittal S, Waggoner AD, et al. Primary results from the SmartDelay determined AV optimization: a comparison to other AV delay methods used in cardiac resynchronization therapy (SMART-AV) trial. Circulation. 2010;122(25):2660-8.
  • Brignole M, Auricchio A, Baron-Esquivias G, Bordachar P, Boriani G, Breithardt OA, et. al. 2013 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy. Rev Esp Cardiol (Engl Ed). 2014;67(1):58.
  • Yokoshiki H, Mitsuyama H, Watanabe M, Mitsuhashi T, Shimizu A. Cardiac resynchronization therapy in ischemic and non-ischemic cardiomyopathy. Journal of arrhythmia. 2017;33(5):410-6.
  • Mullens W, Auricchio A, Martens P, Witte K, Cowie MR, Delgado V, et al. Optimized implementation of cardiac resynchronization therapy: A call for action for referral and optimization of care. EP Europace. 2021;23(8):1324-42.

Kardiyak Resenkronizasyon Tedavisi ve AV Optimizasyonu: Non-İnvaziv Tekniklerle Hemodinamik Değerlendirme

Year 2025, Issue: Early Access
https://doi.org/10.18678/dtfd.1661965

Abstract

Amaç: Bu çalışmada, semptomatik sistolik kalp yetmezliği ve kardiyak resenkronizasyon tedavisine yanıt vermeyen sol dal bloğu olan hastalarda, biventriküler kalp pillerinin atriyoventriküler (AV) optimizasyonunun, özellikle mitral doluş ve aort kapak hız-zaman integrali (VTI) olmak üzere, kardiyak hemodinamik parametreler üzerindeki etkisinin impedans kardiyografi (ICG) ve ekokardiyografi (ECHO) kullanarak değerlendirilmesi amaçlanmıştır.
Gereç ve Yöntemler: Çalışmaya, biventriküler kalp pili implantasyonu yapılmış olan ve aort darlığı, dekompanse kalp yetmezliği bulunmayan veya daha önce ekokardiyografik olarak AV interval optimizasyonu yapılmamış yaşları 18 ile 80 arasında, 10 (%50) erkek ve 10 (%50) kadın olmak üzere 20 hasta dahil edildi. Hemodinamik değerler, ICG ölçümlerini takiben hesaplandı.
Bulgular: AV optimizasyonu sonrası ortalama AV gecikme süresi değişmemiştir (p=0,685). Bununla birlikte, optimizasyon, mitral doluş VTI ve aort kapak VTI bakımından istatistiksel olarak anlamlı bir artışa neden olmuştur (her iki p<0,001). ICG ile elde edilmiş olan hemodinamik parametrelerde, başlangıç ölçümleri ile karşılaştırıldığında optimizasyon sonrası anlamlı bir değişim gözlenmemiştir. Kalp hızında ise optimizasyon öncesi değerler ile karşılaştırıldığında istatistiksel olarak anlamlı bir azalma olduğu saptanmıştır (p=0,003).
Sonuç: Bu çalışma, ekokardiyografik parametrelerde AV optimizasyonuna atfedilebilecek önemli bir iyileşme tespit etmiştir. AV optimizasyonu ile elde edilen sonuçlar, büyük ölçekli randomize çalışmalar ile tutarlılık göstermektedir. Bununla birlikte, bireysel hasta yanıtları ve uzun vadeli etkiler açısından değerlendirmek için daha kapsamlı çalışmalara ihtiyaç vardır.

References

  • Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM, et al. AHA/ACC/HFSA guideline for the management of heart failure: a report of the American college of cardiology/American heart association joint committee on clinical practice guidelines. Circulation. 2022;145(18):e895-1032.
  • Butter C, Seifert M, Georgi C, Iliodromitis K, Bogossian H. Cardiac resynchronization therapy: current guidelines and recent advances beyond drug treatment. Curr Pharm Des. 2023;29(20):1557-63.
  • McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M, et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2021;42(36):3599-726.
  • Santoro A, Landra F, Marallo C, Taddeucci S, Sisti N, Pica A, et al. Biventricular or conduction system pacing for cardiac resynchronization therapy: a strategy for cardiac resynchronization based on a hybrid approach. J Cardiovasc Dev Dis. 2023;10(4):169.
  • Bozkurt B, Coats AJS, Tsutsui H, Abdelhamid CM, Adamopoulos S, Albert N, et al. Universal definition and classification of heart failure: a report of the Heart Failure Society of America, Heart Failure Association of the European Society of Cardiology, Japanese Heart Failure Society and Writing Committee of the Universal Definition of Heart Failure. Eur J Heart Fail. 2021;23(3):352-80.
  • Bristow MR, Saxon LA, Boehmer J, Krueger S, Kass DA, De Marco T, et al. Cardiac-resynchronization therapy with or without an implantable defibrillator in advanced chronic heart failure. N Engl J Med. 2004;350(21):2140-50.
  • Moss AJ, Hall WJ, Cannom DS, Klein H, Brown MW, Daubert JP, et al. Cardiac-resynchronization therapy for the prevention of heart-failure events. N Engl J Med. 2009;361(14):1329-38.
  • Tang AS, Wells GA, Talajic M, Arnold MO, Sheldon R, Connolly S, et al. Cardiac resynchronization therapy for mild-to-moderate heart failure. N Engl J Med. 2010;363(25):2385-95.
  • Cleland JG, Daubert JC, Erdmann E, Freemantle N, Gras D, Kappenberger L, et al. The effect of cardiac resynchronization on morbidity and mortality in heart failure. N Engl J Med. 2005;352(15):1539-49.
  • Dickstein K, Vardas PE, Auricchio A, Daubert JC, Linde C, McMurray J, et al. 2010 focused update of ESC Guidelines on device therapy in heart failure. Eur J Heart Fail. 2010;12(11):1143-53.
  • Beshai JF, Grimm RA, Nagueh SF, Baker JH 2nd, Beau SL, Greenberg SM, et al. Cardiac-resynchronization therapy in heart failure with narrow QRS complexes. N Engl J Med. 2007;357(24):2461-71.
  • Chung ES, Leon AR, Tavazzi L, Sun JP, Nihoyannopoulos P, Merlino J, et al. Results of the Predictors of Response to CRT (PROSPECT) trial. Circulation. 2008;117(20):2608-16.
  • Qamruddin S, Rafie R, Tasneem Z. Discordant left and right ventricular optimal atrioventricular and interventricular delays during biventricular pacemaker optimization. Echocardiography. 2013;30(7):751-8.
  • van Bommel RJ, Bax JJ, Abraham WT, Chung ES, Pires LA, Tavazzi L, et al. Characteristics of heart failure patients associated with good and poor response to cardiac resynchronization therapy: a PROSPECT (Predictors of Response to CRT) sub-analysis. Eur Heart J. 2009;30(20):2470-7.
  • Dickstein K, Cohen-Solal A, Filippatos G, McMurray JJ, Ponikowski P, Poole-Wilson PA, et al. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: the Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2008 of the European Society of Cardiology. Eur Heart J. 2008;29(19):2388-442.
  • Cohen J. Statistical power analysis for the behavioral sciences. 2nd ed. Hillsdale, NJ: Lawrence Erlbaum Associates; 1988.
  • Akkoca A, Büyükakilli B, Balli E, Gültekin B, Özbay E, Oruç Demirbağ H, et al. Protective effect of MitoTEMPO against cardiac dysfunction caused by ischemia-reperfusion: MCAO stroke model study. Int J Neurosci. 2024;134(12):1582-93.
  • De Pasquale MJ, Fossa AA. Use of bioimpedance for measuring cardiac output in the conscious dog. Drug Dev Res. 1996;38(2):105-13.
  • Bernstein DP. A new stroke volume equation for thoracic electrical bioimpedance: theory and rationale. Crit Care Med. 1986;14(10):904-9.
  • Turkseven CH, Pekoglu E, Buyukakilli B. Hemodynamic effects of epinephrine in rats: evaluation by impedance cardiography. Bratisl Lek Listy. 2017;118(10):613-7.
  • Mosteller RD. Simplified calculation of body-surface area. N Engl J Med. 1987;317(17):1098.
  • Moss AJ, Hall WJ, Cannom DS, Klein H, Brown MW, Daubert JP, et al. Cardiac-resynchronization therapy for the prevention of heart-failure events. N Engl J Med. 2009;361(14):1329-38.
  • Daubert C, Behar N, Martins RP, Mabo P, Leclercq C. Avoiding non-responders to cardiac resynchronization therapy: a practical guide. Eur Heart J. 2017;38(19):1463-72.
  • Varma N, Boehmer J, Bhargava K, Yoo D, Leonelli F, Costanzo M, et al. Evaluation, management, and outcomes of patients poorly responsive to cardiac resynchronization device therapy. J Am Coll Cardiol. 2019;74(21):2588-603.
  • Moulin T, Hamon D, Djouadi K, D'Humières T, Elbaz N, Boukantar M, et al. Impact of cardiac resynchronization therapy optimization inside a heart failure programme: a real-world experience. ESC Heart Fail. 2022;9(5):3101-12.
  • Glikson M, Nielsen JC, Kronborg MB, Michowitz Y, Auricchio A, Barbash IM, et al. 2021 ESC guidelines on cardiac pacing and cardiac resynchronization therapy. Eur Heart J. 2021;42(35):3427-520.
  • Auricchio A, Prinzen FW. Non-responders to cardiac resynchronization therapy: The magnitude of the problem and the issues. Circ J. 2011;75(3):521-7.
  • Linde C. CRT-P or CRT-D in heart failure patients: The RESET-CRT project-a prelude to the randomized controlled RESET-CRT study. Eur Heart J. 2022;43(27):2600-2.
  • Naqvi TZ, Rafique AM, Peter CT. Echo-driven V-V optimization determines clinical improvement in non responders to cardiac resynchronization treatment. Cardiovasc Ultrasound. 2006;4:39.
  • Oğuz E. Cardiac resynchronization therapy. In: Oto A, Aytemir K, Çeliker A, Köse S, Özin B, editors. Permanent pacemakers and implantable defibrillators. Ankara: Hacettepe Üniversitesi Hastaneleri Basım Evleri; 2006. p.191-200. Turkish.
  • Borek PP. Cardiac resynchronization therapy. In: Griffin BP, Topol EJ, editors. Manual of cardiovascular medicine. Atalar E, trans. editor. 3rd ed. Ankara: Güneş Tıp Kitabevi; 2010. p.734-42. Turkish.
  • Dupuis M, Noel-Savina E, Prévot G, Tétu L, Pillard F, Rivière D, et al. Determination of cardiac output in pulmonary hypertension using impedance cardiography. Respiration. 2018;96(6):500-6.
  • Guha A, Arora D, Mehta Y. Comparative study of cardiac output measurement by regional impedance cardiography and thermodilution method in patients undergoing off pump coronary artery bypass graft surgery. Ann Card Anaesth. 2022;25(3):335-42.
  • Kim GE, Kim SY, Kim SJ, Yun SY, Jung HH, Kang YS, et al. Accuracy and efficacy of impedance cardiography as a non-invasive cardiac function monitor. Yonsei Med J. 2019;60(8):735-41.
  • Ellenbogen KA, Gold MR, Meyer TE, Fernndez Lozano I, Mittal S, Waggoner AD, et al. Primary results from the SmartDelay determined AV optimization: a comparison to other AV delay methods used in cardiac resynchronization therapy (SMART-AV) trial. Circulation. 2010;122(25):2660-8.
  • Brignole M, Auricchio A, Baron-Esquivias G, Bordachar P, Boriani G, Breithardt OA, et. al. 2013 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy. Rev Esp Cardiol (Engl Ed). 2014;67(1):58.
  • Yokoshiki H, Mitsuyama H, Watanabe M, Mitsuhashi T, Shimizu A. Cardiac resynchronization therapy in ischemic and non-ischemic cardiomyopathy. Journal of arrhythmia. 2017;33(5):410-6.
  • Mullens W, Auricchio A, Martens P, Witte K, Cowie MR, Delgado V, et al. Optimized implementation of cardiac resynchronization therapy: A call for action for referral and optimization of care. EP Europace. 2021;23(8):1324-42.
There are 38 citations in total.

Details

Primary Language English
Subjects Cardiology, Human Biophysics
Journal Section Research Article
Authors

İdris Pektaş 0009-0008-5771-0886

Dilek Çiçek Yılmaz 0000-0003-1432-8931

Çağatay Han Türkseven 0000-0002-0584-0661

Belgin Büyükakıllı 0000-0003-1153-2558

Early Pub Date October 1, 2025
Publication Date October 6, 2025
Submission Date March 20, 2025
Acceptance Date September 4, 2025
Published in Issue Year 2025 Issue: Early Access

Cite

APA Pektaş, İ., Çiçek Yılmaz, D., Türkseven, Ç. H., Büyükakıllı, B. (2025). Cardiac Resynchronization Therapy and AV Optimization: A Hemodynamic Evaluation with Non-Invasive Techniques. Duzce Medical Journal(Early Access). https://doi.org/10.18678/dtfd.1661965
AMA Pektaş İ, Çiçek Yılmaz D, Türkseven ÇH, Büyükakıllı B. Cardiac Resynchronization Therapy and AV Optimization: A Hemodynamic Evaluation with Non-Invasive Techniques. Duzce Med J. October 2025;(Early Access). doi:10.18678/dtfd.1661965
Chicago Pektaş, İdris, Dilek Çiçek Yılmaz, Çağatay Han Türkseven, and Belgin Büyükakıllı. “Cardiac Resynchronization Therapy and AV Optimization: A Hemodynamic Evaluation With Non-Invasive Techniques”. Duzce Medical Journal, no. Early Access (October 2025). https://doi.org/10.18678/dtfd.1661965.
EndNote Pektaş İ, Çiçek Yılmaz D, Türkseven ÇH, Büyükakıllı B (October 1, 2025) Cardiac Resynchronization Therapy and AV Optimization: A Hemodynamic Evaluation with Non-Invasive Techniques. Duzce Medical Journal Early Access
IEEE İ. Pektaş, D. Çiçek Yılmaz, Ç. H. Türkseven, and B. Büyükakıllı, “Cardiac Resynchronization Therapy and AV Optimization: A Hemodynamic Evaluation with Non-Invasive Techniques”, Duzce Med J, no. Early Access, October2025, doi: 10.18678/dtfd.1661965.
ISNAD Pektaş, İdris et al. “Cardiac Resynchronization Therapy and AV Optimization: A Hemodynamic Evaluation With Non-Invasive Techniques”. Duzce Medical Journal Early Access (October2025). https://doi.org/10.18678/dtfd.1661965.
JAMA Pektaş İ, Çiçek Yılmaz D, Türkseven ÇH, Büyükakıllı B. Cardiac Resynchronization Therapy and AV Optimization: A Hemodynamic Evaluation with Non-Invasive Techniques. Duzce Med J. 2025. doi:10.18678/dtfd.1661965.
MLA Pektaş, İdris et al. “Cardiac Resynchronization Therapy and AV Optimization: A Hemodynamic Evaluation With Non-Invasive Techniques”. Duzce Medical Journal, no. Early Access, 2025, doi:10.18678/dtfd.1661965.
Vancouver Pektaş İ, Çiçek Yılmaz D, Türkseven ÇH, Büyükakıllı B. Cardiac Resynchronization Therapy and AV Optimization: A Hemodynamic Evaluation with Non-Invasive Techniques. Duzce Med J. 2025(Early Access).