Echocardiographic imaging in patients with conduction system pacing

Area of Science:

• Cardiology
• Medical Imaging
• Biomedical Engineering

Background:

• Conventional right ventricular pacing (RVP) can lead to pacing-induced cardiomyopathy (PiCM).
• Conduction system pacing (CSP), including His-bundle pacing (HBP) and left bundle branch area pacing (LBBAP), offers a more physiological alternative by activating the left ventricle more naturally.
• Echocardiography is essential for assessing cardiac function and guiding pacing strategies.

Purpose of the Study:

• To review the current literature on the application of echocardiography in conduction system pacing (CSP).
• To highlight echocardiography's role in patient selection, lead placement optimization, and post-procedure monitoring of CSP.
• To explore advanced echocardiographic techniques for evaluating CSP outcomes.

Main Methods:

• Review of current literature on echocardiography in CSP.
• Inclusion of case images demonstrating echocardiographic assessments for CSP.
• Discussion of echocardiographic parameters such as left ventricular ejection fraction (LVEF), global longitudinal strain (GLS), and valvular function.

Main Results:

• Echocardiography aids in determining pacing strategy based on LVEF and assessing lead placement within the interventricular septum.
• Advanced echocardiography, including 3D imaging and speckle-tracking, enhances assessment of lead localization, valvular function, and cardiac dyssynchrony.
• Echocardiography is vital for monitoring CSP effects on LV and RV function, tricuspid regurgitation, and synchrony, with GLS showing early promise.

Conclusions:

• Echocardiography is integral to the clinical use of CSP, from initial patient selection to long-term follow-up.
• Advanced echocardiographic techniques, particularly GLS and 3D imaging, offer valuable insights into CSP efficacy and patient outcomes.
• Standardization of echocardiographic assessments for CSP is needed to optimize its clinical application.