Editorial: Developments in cardiac implantable electronic device therapy: how can we improve clinical implementation?

Area of Science:

• Cardiology
• Electrophysiology
• Medical Devices

Background:

• Cardiac resynchronization therapy (CRT) using biventricular pacing improves outcomes in heart failure patients with left ventricular (LV) dysfunction.
• Traditional CRT often involves complex lead placement and potential complications.
• Left bundle branch area pacing (LBBAP) has emerged as a potentially simpler and more effective pacing strategy.

Discussion:

• LBBAP targets the native conduction system, potentially leading to more physiological LV activation compared to CRT.
• Studies suggest LBBAP can achieve high pacing success rates and improve LV ejection fraction (LVEF).
• Comparison of LBBAP with CRT-D in terms of long-term efficacy, safety, and patient-reported outcomes is crucial.

Key Insights:

• LBBAP demonstrates comparable or superior efficacy to CRT in improving LVEF and QRS duration.
• Pacing parameters and patient selection are critical for successful LBBAP implantation.
• LBBAP may be a viable alternative for patients with CRT non-response or specific anatomical challenges.

Outlook:

• Further large-scale randomized controlled trials are needed to confirm the long-term benefits of LBBAP.
• Exploring LBBAP in different patient subgroups and in combination with other CIEDs (cardiac implantable electronic devices) is warranted.
• Advancements in LBBAP techniques and device technology will likely expand its clinical application.