'Optimized' LV only pacing using a dual chamber pacemaker as a cost effective alternative to CRT

Area of Science:

• Cardiology
• Biomedical Engineering

Background:

• Cardiac Resynchronization Therapy (CRT) is underutilized in developing nations due to high costs.
• Left Ventricle Only Pacing (LVOP) is explored as a cost-effective alternative.

Purpose of the Study:

• To evaluate optimized LVOP using 2D strain imaging and ECG as a viable alternative to CRT.
• To assess the feasibility of achieving cardiac synchrony in heart failure patients with LBBB and intact AV conduction.

Main Methods:

• Four patients with symptomatic heart failure underwent LVOP.
• Optimization involved programming AV delay using 12-lead ECG and 2D strain imaging to minimize the difference between Time to Peak longitudinal strain and Aortic valve Closure (Diff TPL-AC).

Main Results:

• The mean optimal AV delay was 150 ms.
• After 6 months, patients improved by at least one NYHA class.
• Mean QRS duration reduced by 54.5 ms, and mean ejection fraction improved by 7%.

Conclusions:

• Optimized LVOP is a cost-effective alternative to CRT for selected heart failure patients.
• This method achieves electrical and mechanical synchrony, leading to significant clinical improvement.