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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
Pacing treatment for dilated cardiomyopathy: optimization of resynchronization pacing in pediatrics
E Anne Greene1, Charles I Berul
1Division of Cardiology, Children's National Medical Center, George Washington University, Washington, District of Columbia 20011, USA. eagreene@cnmc.org
Insights
Cardiac resynchronization therapy (CRT) is increasingly valuable for pediatric and congenital heart disease patients with ventricular dyssynchrony. Advances in diagnostics improve patient evaluation and treatment optimization.
Area of Science:
- Cardiology
- Pediatric Electrophysiology
Background:
- Understanding of pacing in pediatric and congenital heart disease is evolving.
- Ventricular dyssynchrony and dilated cardiomyopathy are common in this population.
Purpose of the Study:
- Critically evaluate the utility and feasibility of cardiac resynchronization therapy (CRT).
- Summarize recent developments in CRT for pediatric and congenital heart disease.
Main Methods:
- Review of longer-term data for pediatric and congenital heart patients.
- Assessment of technical improvements in CRT procedures, including lead placement.
- Utilizing innovations in echocardiography for assessing dyssynchrony and cardiac function.
Main Results:
- Longer-term data now available for pediatric and congenital heart populations.
- Technical CRT aspects improved, including hybrid systems and lead placement.
- Echocardiography innovations aid in assessing mechanical and electrical dyssynchrony.
Conclusions:
- CRT is a valuable tool for ventricular dyssynchrony and dilated cardiomyopathy in pediatric and congenital heart disease.
- Diagnostic advances enable better patient evaluation, treatment, and optimization.
- Refined indications and impact of CRT in this population are expected with further data collection.
Purpose Of Review:
The understanding of the therapeutic effects and complications of pacing in pediatric and congenital-heart disease is evolving. The utility and feasibility of cardiac resynchronization therapy (CRT) are now being critically evaluated. This group of patients is heterogeneous, but many individuals eventually share a common clinical destiny of ventricular dyssynchrony and dilated cardiomyopathy. This review will summarize the most recent germane developments in this rapidly changing field.
Recent Findings:
Longer-term data are now available for the pediatric and congenital heart population. Some of the technical aspects of this procedure have been improved, including the use of unique combinations of lead placement including hybrid systems. Innovations in echocardiography provide the clinician with the capability to assess mechanical dyssynchrony indices, as well as cardiac function and electrical dyssynchrony, when considering a pediatric or congenital heart disease patient for CRT.
Summary:
CRT is becoming a valuable tool in the treatment of ventricular dyssynchrony and dilated cardiomyopathy in pediatric and congenital heart disease patients. Diagnostic advances in electrophysiology and echocardiography have enabled clinicians to more effectively evaluate, treat, and optimize device programming for patients before and after CRT. These modalities also allow more detailed data collection, which may aid in the refinement of indications and impact of CRT in this unique population.
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