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Updated: May 2, 2026

Benefits of Cardiac Resynchronization Therapy in an Asynchronous Heart Failure Model Induced by Left Bundle Branch Ablation and Rapid Pacing
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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

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New developments in the delivery of cardiac resynchronization therapy: targeted lead placement, multi-site and

Manav Sohal1, Zhong Chen, Eva Sammut

  • 1Division of Imaging Sciences and Biomedical Engineering, King's College London, Rayne Institute, 4th Floor Lambeth Wing, St. Thomas' Hospital, London SE1 7EH, UK.

Expert Review of Medical Devices
|March 7, 2014
PubMed

Insights

Cardiac resynchronization therapy (CRT) improves heart failure outcomes, but one-third of patients do not respond. Optimizing CRT lead placement and exploring alternative pacing methods may improve patient response rates.

Area of Science:

  • Cardiology
  • Medical Devices
  • Heart Failure Management

Background:

  • Cardiac resynchronization therapy (CRT) is established for heart failure with ventricular dyssynchrony.
  • Current CRT response rates are suboptimal, with up to 33% of patients not benefiting.
  • Existing guidelines for CRT lead placement may not be universally effective, especially in patients with cardiac scar tissue.

Purpose of the Study:

  • To explore strategies for improving CRT response rates in non-responders.
  • To investigate the potential benefits of targeting the latest mechanically activating segment for left ventricular (LV) lead placement.
  • To evaluate alternative CRT delivery methods, including multi-site and endocardial pacing.

Main Methods:

  • Review of current CRT practices and outcomes.
  • Analysis of emerging techniques for LV lead positioning, focusing on mechanical activation patterns.
  • Examination of data from trials investigating multi-site and LV endocardial pacing.

Main Results:

  • Empirical lead placement may be insufficient, particularly in patients with significant myocardial scar.
  • Targeting the latest mechanically activating segment for LV lead placement shows potential benefit.
  • Alternative pacing strategies like multi-site and endocardial pacing demonstrate promise.

Conclusions:

  • A shift from solely relying on response prediction to optimizing CRT delivery is crucial.
  • Personalized LV lead placement based on mechanical activation may enhance CRT efficacy.
  • Investigating novel delivery methods offers a promising avenue to improve outcomes for CRT non-responders.

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