Conduction System Pacing Upgrade in Chronic Heart Failure with Severe Left Ventricular Dysfunction and Chronic Atrial...

Area of Science:

• Cardiology
• Electrophysiology
• Medical Devices

Background:

• Cardiac resynchronization therapy (CRT) is a standard treatment for severe congestive heart failure.
• Approximately one-third of patients undergoing CRT do not respond to the therapy.
• Conduction system pacing (CSP), encompassing His-bundle pacing (HBP) and left bundle branch area pacing (LBBAP), has emerged as a promising alternative and adjunct to CRT.

Purpose of the Study:

• To describe a novel approach for upgrading patients to CRT with CSP.
• To present a case series demonstrating the feasibility of utilizing atrial ports for HBP and LBBAP leads during CRT upgrades.
• To evaluate the efficacy and simplicity of this combined CRT and CSP strategy.

Main Methods:

• Two cases of patients with end-stage heart failure were upgraded to CRT with CSP.
• HBP and LBBAP leads were implanted and connected to the atrial ports of an implantable cardiac defibrillator/CRT-defibrillator.
• The procedure involved utilizing existing atrial ports for the novel pacing leads.

Main Results:

• The implantation of HBP and LBBAP leads into atrial ports was technically successful in both cases.
• The upgraded CRT with CSP therapy was deemed a simple, reasonable, and effective treatment.
• This approach addresses the lead connection challenge in combined CRT and CSP systems.

Conclusions:

• Upgrading to CRT with CSP by utilizing atrial ports for HBP and LBBAP leads is a viable strategy.
• This method offers a simple and effective solution for patients with severe heart failure.
• CSP combined with CRT may enhance treatment efficacy compared to CRT alone.