Optimal Cardiac Resynchronization Therapy with Conduction System Pacing Guided by Electro-Anatomical Mapping: A Case...

Area of Science:

• Cardiology
• Electrophysiology
• Medical Devices

Background:

• Biventricular pacing has been the standard for cardiac resynchronization therapy (CRT) in patients with left bundle branch block (LBBB) and reduced ejection fraction.
• Conduction system pacing (CSP) is emerging as a potentially superior alternative, offering improved left ventricular function outcomes.
• Both biventricular pacing and CSP are limited by long fluoroscopy times.

Observation:

• A 60-year-old patient with non-ischemic dilated cardiomyopathy and LBBB underwent CSP as the primary CRT strategy.
• A 3D electro-anatomical mapping system guided lead placement to the His bundle region and optimal septal penetration.
• Left bundle branch pacing resulted in a narrow QRS complex and low fluoroscopy exposure.

Findings:

• CSP achieved a narrow, paced QRS complex, indicating successful His-Purkinje system activation.
• The procedure utilized low fluoroscopy exposure, addressing a key limitation of current CRT techniques.
• Three-month follow-up revealed significant improvements in the patient's clinical status and left ventricular function.

Implications:

• 3D electro-anatomical mapping is crucial for the precise targeting required in CSP, enhancing success rates.
• CSP, particularly when guided by 3D mapping, presents a valuable and potentially more effective option for CRT in patients with complex cardiac anatomies.
• This approach may reduce procedure times and improve patient outcomes in CRT.