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Dyssynchronous Heart Failure: A Clinical Review

Sean J Dikdan1, Michael Lawrenz Co1, Behzad B Pavri2

  • 1Thomas Jefferson University Hospital, Philadelphia, PA, 19107, USA.

Current Cardiology Reports
|November 29, 2022
PubMed

Insights

Dyssynchronous heart failure (HFd) occurs when heart chambers contract unevenly, often leading to heart failure. Correcting this dyssynchrony with cardiac resynchronization therapy (CRT) can significantly improve left ventricular function.

Area of Science:

  • Cardiology
  • Heart Failure Research
  • Cardiac Electrophysiology

Background:

  • Ventricular dyssynchrony, particularly affecting the left ventricle, is a significant factor in heart failure development and progression.
  • Dyssynchronous heart failure (HFd) is characterized by the potential for left ventricular recovery upon correction of the underlying dyssynchrony.
  • HFd is often refractory to conventional medical management.

Purpose of the Study:

  • To review the current understanding of the pathophysiology of dyssynchronous heart failure (HFd).
  • To provide clinical examples and discuss current treatment strategies for HFd.
  • To highlight HFd as a distinct etiology of heart failure.

Main Methods:

  • Review of existing literature on ventricular dyssynchrony and heart failure.
  • Analysis of treatment outcomes for HFd, including conventional biventricular pacing and conduction system pacing.
  • Discussion of the pathophysiology and clinical presentation of HFd.

Main Results:

  • Conventional biventricular pacing (BVP), a form of cardiac resynchronization therapy (CRT), offers proven benefits in HFd but has a notable non-responder rate.
  • Emerging techniques like His bundle or left bundle branch area pacing show promise for correcting HFd.
  • HFd demonstrates a superior response to CRT compared to other heart failure etiologies.

Conclusions:

  • Dyssynchronous heart failure (HFd) should be recognized as a specific cause of heart failure.
  • Cardiac resynchronization therapy (CRT) is the most effective treatment for HFd.
  • Conduction system pacing represents a promising advancement in CRT for HFd.
Abstract

Keywords:
Chronic resynchronization therapyConduction system pacingDyssynchrony-mediated cardiomyopathyHis bundle pacingLeft bundle area pacingVentricular dyssynchrony

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