A method and system determining reversible cardiac dssynchrony (i.e. ventricular or mechanical dssynchrony), includes detecting a shortening of a delay to myocardial synergy, D, using measurements of an event resulting from D. There are one or more sensors to measure biopotential/s (e.g. to produce an ECG), at least one electrode for pacing, and a processor. One or more sensors (e.g. accelerometer) may detect and record the time of a heart event e.g. peak pressure. The processor identifies cardiac dyssynchrony based on a calculation of a first time delay between the heart event time and a reference time (e.g. full duration of a QRS signal). Pacing is applied to the heart. A second time delay is then calculated. If the second delay is shorter than the first delay, reversible cardiac dyssynchrony is determined. Identification of reversible cardiac dyssynchrony may be used to select heart failure patients most likely to respond to Cardiac Resynchronisation Therapy (CRT). Preferably, an optimal pacing mode, number of electrodes, and electrode positions are optimised for CRT or pacing therapy. A method may generate a 3D mesh of part of the heart to determine best positions for electrodes in CRT.
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