7,9,15 Anatomical limitations such as lack of suitable venous branches and unavoidable phrenic nerve stimulation at suitable anatomic LV lead positions affect the success of coronary sinus lead implantation. However, about 30% of patients receiving BVP-CRT do not derive a detectable clinical or echocardiographic benefit and some worsen after resynchronisation. BVP-CRT may also benefit patients who develop an RV pacing-induced cardiomyopathy (PICM), which is another form of ventricular dyssynchrony, and patients with a low LVEF undergoing implantation of a new or replacement pacemaker or ICD with an anticipated requirement for a significant percentage (>40%) of ventricular pacing. 7–12 The patients who derive the most benefit from BVP-CRT are those with HF with reduced ejection fraction (HFrEF) and left bundle branch block (LBBB). Several large, randomised studies have demonstrated improved quality of life, increased exercise capacity, reduced HF hospitalisation and decreased all-cause mortality with the use of traditional BVP-CRT. It is as an integral part of therapy for patients with HF with depressed left ventricular ejection fraction (LVEF) and a wide QRS, which implies inter-ventricular dyssynchrony. In this paper, we provide a comprehensive review of CSP for CRT including a review of the available data on CSP among various indications for CRT.īVP is the conventional form of CRT (BVP-CRT). This has allowed the use of these strategies for CRT, either as a first-line therapy or as a rescue strategy when BVP fails.
7 Although not a new concept, HBP and LBBP have been successful in overcoming bundle branch block (BBB) and result in ventricular synchrony, particularly in patients with more proximal disease. 6 Over the past decade, these techniques have gained significant popularity and specific tools have been designed to enhance lead delivery.Ĭardiac resynchronisation therapy (CRT), which has traditionally been performed using biventricular pacing (BVP), in addition to guideline directed medical therapy, is the cornerstone treatment for patients with cardiomyopathy, heart failure (HF) and ventricular dyssynchrony. in 2018 and involves placement of a pacing lead through the inter-ventricular septum closer to the main trunk of the LBB, bypassing areas of AV conduction disease. 2–5 LBBP was first described by Huang et al. There are a number of observational studies that have demonstrated the clinical benefits of HBP over conventional right ventricular (RV) pacing. HBP was first described by Deshmukh et al. Lead placement for CSP can be targeted either at the bundle of His, known as His bundle pacing (HBP), or at the region of the left bundle branch (LBB), known as LBB pacing (LBBP). Conduction system pacing (CSP) is a therapy that involves the placement of permanent pacing leads along different sites of the cardiac conduction system with the intent of overcoming sites of atrioventricular (AV) conduction disease and delay, thereby providing a pacing solution that results in more synchronised biventricular activation.
0 kommentar(er)
