Alternative left ventricular pacing approaches for optimal cardiac resynchronization therapy
Vincent Galand1, Jagmeet P Singh2, Christophe Leclercq1
1Université Rennes, CHU Rennes, Rennes, France.
Insights
Cardiac resynchronization therapy (CRT) can improve heart failure outcomes, but some patients don't benefit. This review explores advancements beyond traditional coronary sinus pacing to enhance CRT effectiveness.
Area of Science:
- Cardiology
- Biomedical Engineering
Background:
- Cardiac resynchronization therapy (CRT) benefits selected heart failure patients with impaired ejection fraction.
- A significant percentage of CRT recipients (20-40%) experience suboptimal clinical outcomes.
- Challenges with coronary sinus (CS) lead implantation, including anatomical and electrical constraints, limit CRT efficacy.
Purpose of the Study:
- To review the evolution of left ventricular (LV) lead implantation techniques in CRT.
- To discuss alternative biventricular pacing strategies aimed at improving CRT response.
- To compare traditional CS pacing with newer approaches like wireless LV stimulation and His-bundle pacing.
Main Methods:
- Literature review of advancements in CRT lead technology and pacing strategies.
- Analysis of challenges associated with conventional coronary sinus lead placement.
- Exploration of emerging techniques for LV lead implantation.
Main Results:
- Conventional CS pacing presents anatomical and electrical limitations for optimal LV lead positioning.
- Newer techniques such as wireless LV stimulation and His-bundle pacing offer potential solutions to overcome CS limitations.
- These alternative methods aim to improve CRT response rates in non-responders.
Conclusions:
- The development of novel LV pacing strategies is crucial for expanding CRT benefits.
- Wireless LV stimulation and His-bundle pacing represent promising alternatives to traditional CS pacing.
- Continued innovation in lead implantation is essential for optimizing CRT in heart failure management.
Abstract:
Cardiac resynchronization therapy (CRT) improves mortality, morbidity, and quality of life in selected heart failure patients with severe left ventricular (LV) ejection fraction impairment. However, between 20% and 40% of device recipients do not benefit clinically from CRT. Indeed, some anatomic and technical difficulties are related to the coronary venous implantation site via the coronary sinus (CS). Additionally, electrical constraints have been described, and CS does not always correspond to the optimal LV lead position. In the last decade, engineers and physicians have worked together to overcome the challenging LV lead implantation, and various biventricular pacing alternatives have been developed to improve CRT response. In this review, we discuss the evolution from CS pacing to wireless LV stimulation and His-bundle pacing.
Related Concept Videos
01:24Cardiac Catheterization III: Left Heart Catheterization
02:18Alternative RNA Splicing
There are five types of alternative RNA splicing that vary in the ways the pre-mRNA segments are removed or retained in the mature mRNA. The first...
02:18Alternative RNA Splicing
01:16Null and Alternative Hypotheses
The null hypothesis, denoted by H0 is a statement of no difference between the variables—they are not related. This can often be considered the status quo. As a result if you cannot accept the null, it requires some action.
The alternative hypothesis, denoted by H1 or Ha, is a claim about the...
00:59Gene Therapy
00:48Optimal Foraging