Related Experiment Video

Updated: Oct 12, 2025

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

10.6K

Usefulness of Multisite Ventricular Pacing in Nonresponders to Cardiac Resynchronization Therapy

Samir Saba1, Devi Nair2, Christopher R Ellis3

  • 1Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.

The American Journal of Cardiology
|November 24, 2021
PubMed

Insights

Left ventricular (LV) multisite pacing (MSP) offers a safe and effective solution for heart failure patients who don't respond to cardiac resynchronization therapy (CRT). This innovative approach converts approximately 50% of non-responders, improving their outcomes.

Area of Science:

  • Cardiology
  • Medical Devices
  • Heart Failure Management

Background:

  • Cardiac resynchronization therapy (CRT) is a standard treatment for heart failure with impaired myocardial function and delayed ventricular activation.
  • A significant portion of patients (25%-40%) do not achieve a positive response to CRT.
  • Left ventricular (LV) multisite pacing (MSP) is being investigated as a method to enhance CRT response rates.

Purpose of the Study:

  • To evaluate the safety and efficacy of utilizing the LV MSP feature in patients who are non-responders to CRT.
  • To assess the clinical composite score (CCS) changes and complication rates associated with LV MSP.

Main Methods:

  • The Strategic Management to Improve CRT Using Multi-Site Pacing (SMART-CRT) trial enrolled 584 CRT-defibrillator recipients.
  • 102 non-responders had the LV MSP feature activated and were evaluated at 6 and 12 months using the CCS.
  • Safety was assessed by the complication-free rate, and efficacy by the proportion of patients with improved CCS.

Main Results:

  • The LV MSP feature demonstrated a high complication-free rate of 99.0%, exceeding the performance goal of 90%.
  • Approximately 51.3% of CRT non-responders showed an improved CCS from 6 to 12 months, surpassing the 5% performance goal.
  • The LV MSP feature was associated with an estimated reduction of 3.6 months in CRT-defibrillator battery longevity.

Conclusions:

  • LV MSP is a safe and effective strategy for managing CRT non-responders, achieving a conversion rate of around 50%.
  • This approach offers a significant improvement in clinical outcomes for a substantial number of non-responding patients.
  • LV MSP should be considered as a valuable option in the treatment algorithm for patients with heart failure who do not benefit from standard CRT.

More Related Videos

Real-Time Cardiac Mapping with a Noninvasive Imageless Electrocardiographic Imaging System10:17

Real-Time Cardiac Mapping with a Noninvasive Imageless Electrocardiographic Imaging System

Published on: April 11, 2025

1.0K
Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock06:10

Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock

Published on: June 12, 2021

3.4K

Related Concept Videos

Cardiomyopathy V: Interprofessional Care01:29

Cardiomyopathy 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...
64
Cardiomyopathy II: Dilated Cardiomyopathy01:30

Cardiomyopathy 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,...
63
Heart Failure Drugs: Inotropic Agents01:26

Heart Failure Drugs: Inotropic Agents

Positive inotropic agents are commonly used as the first line of treatment for heart failure. One such agent is digoxin, derived from the genus Digitalis, which has been known for centuries but effectively utilized since 1785. However, these cardiac glycosides can have potentially toxic effects due to their mechanism of action, which involves inhibiting Na+/K+-ATPase and increasing contractility. Digoxin is absorbed orally and distributed in various tissues, including the CNS. It has a long...
819
Cardiopulmonary Resuscitation III: AED Use01:23

Cardiopulmonary Resuscitation III: AED Use

Introduction to AEDAn Automated External Defibrillator (AED) is a portable medical device that analyzes the heart's rhythm and, if necessary, delivers an electrical shock to help the heart re-establish an effective rhythm during sudden cardiac arrest (SCA). SCA occurs when the heart suddenly and unexpectedly stops beating, leading to a loss of blood flow to the brain and other vital organs. In such emergencies, time is of the essence, and using an AED, combined with Cardiopulmonary...
115
Heart Failure VI: Adjunct Therapies01:22

Heart 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.
53
Cardiopulmonary Resuscitation IV: Pharmacological Management01:25

Cardiopulmonary Resuscitation IV: Pharmacological Management

Pharmacologic intervention is crucial in treating cardiac arrest patients during ACLS or Advanced Cardiovascular Life Support. The ACLS algorithms guide the administration of specific drugs based on the patient's cardiac arrest rhythm, which includes pulseless ventricular tachycardia (VT), ventricular fibrillation (VF), asystole, and pulseless electrical activity (PEA).EpinephrineIndication: Epinephrine is the first-line drug for all cardiac arrest rhythms.Mechanism of Action: Epinephrine...
111