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Cardiac resynchronization therapy guided by interventricular conduction delay: How to choose between biventricular
Carmine Marallo1, Federico Landra1, Simone Taddeucci1
1Department of Biotechnologies, University of Siena, Siena, Italy.
Journal of Cardiovascular Electrophysiology
|October 4, 2024
Summary
Intraoperative interventricular conduction delay (IVCD) assessment improves cardiac resynchronization therapy (CRT) response rates. Selecting between biventricular pacing (BIV) and conduction system pacing (CSP) based on IVCD optimizes patient outcomes in HFrEF with LBBB.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Devices
Background:
- Biventricular pacing (BIV) is standard for cardiac resynchronization therapy (CRT), but 30% of patients do not respond.
- Conduction system pacing (CSP) offers an alternative, with interventricular conduction delay (IVCD) predicting CRT response.
- Identifying optimal CRT strategy is crucial for heart failure with reduced ejection fraction (HFrEF) and left bundle branch block (LBBB).
Purpose of the Study:
- To evaluate the incidence of CRT responders by optimizing the choice between BIV and CSP.
- To utilize intraoperative IVCD measurement to guide the selection of pacing strategy.
- To compare CRT response rates in patients with HFrEF and LBBB based on IVCD-guided pacing selection.
Main Methods:
- Ninety-six patients with HFrEF and LBBB were randomized 1:1 to standard BIV (control) or IVCD-guided CRT (study group).
- In the study group, the pacing strategy (BIV or CSP) was determined by intraoperative RVs-LVs interval (≥100 ms indicated BIV, <100 ms indicated CSP).
- Clinical, EKG, and echocardiographic parameters were assessed pre- and 6 months post-implant to evaluate CRT response.
Main Results:
- 37% of patients in the study group received CSP based on the operative algorithm.
- The study group showed significantly higher CRT response rates (92.5% echocardiographic, 87.5% clinical) compared to the control group (69.8% echocardiographic, 62.8% clinical).
- The study group demonstrated greater improvement in ejection fraction and reduction in ventricular volumes; SG enrollment was the sole predictor of CRT response.
Conclusions:
- Intraoperative IVCD assessment effectively guides the selection between BIV and CSP for CRT.
- This IVCD-guided approach significantly enhances CRT response rates in patients with HFrEF and LBBB.
- Optimizing pacing strategy based on electrical desynchrony markers improves clinical outcomes.
Keywords:
His bundle pacingbiventricular pacingconduction system pacinginterventricular delayleft bundle pacingresponder to CRTMore Related Videos
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