This study aimed to investigate the feasibility of Cardiac Resynchronization Therapy (CRT) achieved through Left Univentricular Pacing (LUVP) Beat-By-Beat Tracking (BBBT) of physiological Atrioventricular Delay (AVD). Thirty-seven patients undergoing CRT were enrolled, and their preoperative atrial premature conduction data were collected. Electrocardiogram (ECG) was used to optimize the LUVP, as well as the AVD, VV, and VR intervals of standard biventricular pacing. The interval from the LUVP pulse to the start of Right Ventricular (LVP-RV) intracavitary ECG was measured, and the LV priority coefficient (e) was calculated. The interval differences between two adjacent sinus heartbeats within 1 min, as well as between the maximum and minimum Atrial Sensing-Ventricular Sensing (AS-VS), were measured and compared. The regression equation for atrial premature AVD was P'R'=0.022+0.954 PR. The LVP-RV interval (102.6 +/- 15.8 ms) was significantly greater than the V-R interval (19.31 +/- 7.32 ms) (P<0.01), and e was 0.73 +/- 0.04. The maximum difference between the AS-VS intervals of two adjacent sinus heartbeats within 1 min (6.43 +/- 1.63 ms) was significantly lower than the difference between the maximum and minimum AS-VS intervals (16.54 +/- 3.32 ms) (P<0.01). LUVP-BBBT could realize CRT.