Related Experiment Video
Updated: Jun 26, 2026
12:45
Benefits of Cardiac Resynchronization Therapy in an Asynchronous Heart Failure Model Induced by Left Bundle Branch Ablation and Rapid Pacing
Published on: December 11, 2017
Cardiac resynchronization therapy and atrial fibrillation
Ganesh S Kamath1, Jonathan S Steinberg
1Al-Sabah Arrhythmia Institute and Division of Cardiology, St. Luke's and Roosevelt Hospitals, Columbia University College of Physicians and Surgeons, New York, NY10025 , USA
Cardiology Journal
|January 9, 2009
Summary
Cardiac resynchronization therapy (CRT) improves heart failure (HF) outcomes. For patients with atrial fibrillation (AF), atrioventricular junction ablation with permanent pacing ensures consistent CRT delivery, improving results.
Area of Science:
- Cardiology
- Electrophysiology
- Heart Failure Management
Background:
- Cardiac resynchronization therapy (CRT) is a key treatment for end-stage heart failure (HF).
- Atrial fibrillation (AF) complicates 15-50% of HF cases, worsening prognosis.
- AF can hinder effective CRT by competing with biventricular pacing, especially during rapid heart rates.
Purpose of the Study:
- To evaluate strategies for optimizing CRT delivery in heart failure patients with atrial fibrillation.
- To assess the efficacy of atrioventricular junction ablation and permanent pacing versus catheter ablation of AF.
Main Methods:
- Review of current literature and device algorithms for CRT in AF patients.
- Analysis of outcomes associated with atrioventricular junction ablation and permanent pacing.
- Consideration of catheter ablation of AF as an alternative strategy.
Main Results:
- Atrioventricular junction ablation with permanent pacing effectively eliminates conducted beat interference, ensuring complete biventricular capture.
- This strategy is associated with improved clinical outcomes in HF patients with AF.
- Catheter ablation of AF offers a potential method for rhythm control.
Conclusions:
- Atrioventricular junction ablation with permanent pacing is a viable strategy to optimize CRT in heart failure patients with atrial fibrillation.
- Further randomized clinical trials are needed to define optimal indications for CRT in this complex patient group.
Related Concept Videos
01:29Disturbances in Heart Rhythm
Arrhythmia or dysrhythmia refers to an abnormal heart rhythm caused by a defect in the heart's conduction system. It can cause the heart to beat irregularly, too quickly, or too slowly, leading to symptoms like chest pain, shortness of breath, and fainting. Factors such as stress, caffeine, alcohol, nicotine, cocaine, certain drugs, congenital defects, diseases, and electrolyte abnormalities can trigger arrhythmias.
Arrhythmias are categorized by their speed, rhythm, and origin. A slow heart...
Arrhythmias are categorized by their speed, rhythm, and origin. A slow heart...
01:25Dysrhythmias VI: Management of Dysrhythmias
Dysrhythmia management involves a multifaceted approach, incorporating pharmacological treatments, medical procedures, surgical interventions, lifestyle modifications, and patient education.Pharmacological ManagementAntiarrhythmic Drugs:Class I (Sodium Channel Blockers): This class includes quinidine and procainamide, which reduce the speed of impulse conduction in the heart, stabilize the cardiac membrane, and control arrhythmias. Quinidine and procainamide are Class IA agents that prolong the...
01:25ECG Interpretation of Arrhythmias II: Atrial, Junctional and Ventricular Arrhythmias
Arrhythmia is a condition characterized by an irregular heart rhythm, with ECG changes that differ based on its origin and nature. The types of arrhythmias discussed below include atrial, junctional, and ventricular arrhythmias.Atrial ArrhythmiasPremature Atrial Complexes (PACs): PACs are early atrial beats caused by stress, caffeine, alcohol, electrolyte imbalances, hypoxia, hyperthyroidism, or certain medications (e.g., bronchodilators and decongestants). The ECG shows early P waves with an...
01:29Cardiomyopathy V: Interprofessional Care
Managing cardiomyopathy involves addressing underlying or precipitating causes, treating heart failure with medications, and implementing dietary changes and a balanced exercise and rest regimen.Lifestyle ModificationsCardiomyopathy patients should adopt a low-sodium diet to reduce fluid retention and manage heart failure. A personalized exercise and rest plan helps maintain physical fitness without overstraining the heart. Avoiding alcohol and tobacco is essential to prevent further damage to...
01:30Cardiomyopathy II: Dilated Cardiomyopathy
Dilated cardiomyopathy, or DCM, is a progressive myocardial disorder characterized by ventricular chamber dilation and contractile dysfunction.EtiologyVarious factors can cause DCM, including hypertension and heavy alcohol intake, which contribute to the weakening and enlargement of the heart muscle. Viral infections, such as Coxsackievirus B, adenoviruses, and influenza, can lead to DCM by causing inflammation and damage to heart tissue. Certain chemotherapeutic agents, including daunorubicin,...
01:22Heart Failure VI: Adjunct Therapies
Additional therapies for treating patients with heart failure (HF) may include procedural interventions, supplemental oxygen, the management of sleep disorders, and nutritional therapy.Procedural InterventionsImplantable Cardioverter-Defibrillator: For patients at risk of life-threatening arrhythmias due to severe left ventricular dysfunction, an Implantable Cardioverter-Defibrillator (ICD) can detect and terminate these arrhythmias, preventing sudden cardiac death and improving survival rates.