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PurposeMultipoint pacing (MPP) improves left ventricular (LV) electrical synchrony in cardiac resynchronization therapy (CRT). SyncAV automatically adjusts atrioventricular delay (AVD) according to intrinsic AV intervals and may further improve synchrony. Their combination has not been assessed. The objective was to evaluate the improvement in electrical synchrony achieved by SyncAV combined with MPP in an international, multicenter study.MethodsPatients with LBBB undergoing CRT implant with a quadripolar lead (Abbott Quartet™) were prospectively enrolled. QRS duration (QRSd) was measured by blinded observers from 12-lead ECG during: intrinsic conduction, BiV pacing (conventional biventricular pacing, nominal static AVD), MPP (2 LV cathodes maximally spaced, nominal static AVD), BiV + SyncAV, and MPP + SyncAV. All SyncAV offsets were individualized for each patient to yield the narrowest QRSd during BiV pacing. QRSd changes were compared by ANOVA and post hoc Tukey-Kramer tests.ResultsOne hundred and three patients were enrolled (65.7 ± 12.1 years, 67% male, 37% ischemic, EF 26.4 ± 6.5%, PR 190.3 ± 39.1 ms). Relative to intrinsic conduction (QRSd of 165 ± 16 ms), BiV reduced QRSd by 11.9% to 145 ± 18 ms (P < 0.001 vs intrinsic), and MPP reduced QRSd by 13.3% to 142 ± 19 ms (P < 0.001 vs intrinsic). However, enabling SyncAV with a patient-optimized offset nearly doubled this QRSd reduction. BiV + SyncAV reduced QRSd by 22.0% to 128 ± 13 ms (P < 0.001 vs BiV), while MPP + SyncAV reduced QRSd further by 25.6% to 122 ± 14 ms (P < 0.05 vs BiV + SyncAV).ConclusionSyncAV can significantly improve acute electrical synchrony beyond conventional CRT, with further improvement achieved by superimposing MPP.

The State Government's submission to the Commonwealth discussion paper \"Higher Education At The Crossroads\" also recommends introducing tax concessions to encourage investment in universities and improving higher education opportunities in remote communities. The submission claims that, without an increase in federal funding, the number of Queenslanders studying at universities could fall from 46 in every 1000 people to 38 in 1000. \"There are better solutions to Australia's stretched higher education system than further slugging students with higher fees or creating two elite universities at the expense of the 36 other public universities across the nation,\" she said.

Mr [Peter Hedge] and his team were believed to be trying to overcome \"complex problems\" to negotiate deals for Qantas and Virgin Blue to use Ansett planes. Both rivals are desperately seeking to expand their capacity to make up for Ansett's demise. Ansett spokeswoman Heather Jeffrey said the administrators were not looking at Ansett as an asset sale but as a business sale. She also said there was \"literally a round the clock effort to see how many people we could gainfully employ\". Virgin Blue's head of commercial operations David Huttner said last night that negotiations were continuing about Ansett 737s and their crews, as well as Queensland-based Flight West's regional operation. He said Virgin was also looking at acquiring 737s from overseas and hiring Ansett crews.

Mr [Peter Hedge] and his team were believed to be trying to overcome \"complex problems\" to negotiate deals for Qantas and Virgin Blue to use Ansett planes. Both rivals are desperately seeking to expand their capacity to make up for Ansett's demise. Ansett spokeswoman Heather Jeffrey said the administrator was not looking at Ansett as an asset sale but as a business sale. She also said there was \"literally a round the clock effort to see how many people we could gainfully employ\". Virgin Blue's head of commercial operations David Huttner said last night that negotiations were continuing about Ansett 737s and their crews, as well as Queensland-based Flight West's regional operation. He said Virgin was also looking at acquiring 737s from overseas and hiring Ansett crews.