Refining Patient Selection Criteria for LV-Only Fusion Pacing in Cardiac Resynchronization Therapy: A Systematic...

Area of Science:

• Cardiology
• Electrophysiology
• Medical Devices

Background:

• Cardiac resynchronization therapy (CRT) using biventricular pacing (BiVp) has limited response rates (60-80%).
• Left ventricle-only fusion cardiac resynchronization therapy (LV-only fCRTp) presents a more physiological pacing approach.
• Optimizing patient selection is crucial for maximizing LV-only fCRTp therapeutic potential.

Purpose of the Study:

• To systematically review clinical outcomes of LV-only fCRTp.
• To identify evidence-based criteria for selecting patients likely to benefit from LV-only fCRTp.
• To enhance long-term therapeutic benefits through improved patient selection.

Main Methods:

• Systematic literature search of PubMed and Cochrane Library up to April 2025.
• Adherence to PRISMA 2020 guidelines for study selection.
• Inclusion of studies on LV-only fCRTp using biventricular or dual-chamber devices.

Main Results:

• Twenty-seven studies met inclusion criteria; 17 used BiV devices, 10 used RA/LV dual-chamber devices.
• Common selection parameters included AV conduction, cardiomyopathy type, and arrhythmia risk.
• RA/LV devices showed consistent benefits and low complications, especially in non-ischemic patients with stable AV conduction.

Conclusions:

• Supplementary selection criteria beyond current guidelines can optimize LV-only fCRTp effectiveness.
• Patient selection significantly influences the stability and success of fusion pacing.
• Further research into specific patient profiles for LV-only fCRTp is warranted.