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Cardiomyopathy V: Interprofessional Care01:29

Cardiomyopathy V: Interprofessional Care

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Managing cardiomyopathy involves addressing underlying or precipitating causes, treating heart failure with medications, and implementing dietary changes and a balanced exercise and rest regimen.Lifestyle ModificationsCardiomyopathy patients should adopt a low-sodium diet to reduce fluid retention and manage heart failure. A personalized exercise and rest plan helps maintain physical fitness without overstraining the heart. Avoiding alcohol and tobacco is essential to prevent further damage to...
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Cardiomyopathy II: Dilated Cardiomyopathy01:30

Cardiomyopathy II: Dilated Cardiomyopathy

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Dilated cardiomyopathy, or DCM, is a progressive myocardial disorder characterized by ventricular chamber dilation and contractile dysfunction.EtiologyVarious factors can cause DCM, including hypertension and heavy alcohol intake, which contribute to the weakening and enlargement of the heart muscle. Viral infections, such as Coxsackievirus B, adenoviruses, and influenza, can lead to DCM by causing inflammation and damage to heart tissue. Certain chemotherapeutic agents, including daunorubicin,...
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Cardiomyopathy I: Introduction and Classification01:25

Cardiomyopathy I: Introduction and Classification

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Cardiomyopathy, or CMP, is a group of diseases affecting the myocardial structure, impairing its ability to pump blood effectively. This condition can lead to arrhythmias, heart failure, or sudden cardiac death.Cardiomyopathies are classified into primary and secondary categories:Primary Cardiomyopathy refers to conditions involving only the heart muscle that are often idiopathic (of unknown cause) or genetic. They primarily affect the myocardium without the involvement of other systemic...
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Cardiomyopathy III: Hypertrophic Cardiomyopathy01:29

Cardiomyopathy III: Hypertrophic Cardiomyopathy

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Hypertrophic cardiomyopathy, or HCM, is an autosomal dominant genetic disorder characterized by asymmetric left ventricular hypertrophy without ventricular dilation. It is more common in men and is typically diagnosed in young, athletic adults.EtiologyHCM is primarily genetic and is caused by mutations in genes encoding sarcomeric proteins. Researchers have identified over 1400 mutations across at least 11 different genes. Among these, the most frequently occurring mutations are found in the...
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Conduction System of the Heart01:19

Conduction System of the Heart

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Autorhythmicity is a term that refers to the heart's inherent ability to generate electrical signals and instigate muscle contractions. This self-regulating conduction system within the heart consists of two key components: the pacemaker cells and specialized conducting cells.
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Mitral Regurgitation I: Introduction01:20

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Mitral regurgitation is characterized by the backward circulation of blood from the left ventricle to the left atrium during systole, a phase of the cardiac cycle when the heart contracts and pumps blood out of the chambers. This abnormal flow occurs primarily due to the dysfunction of the mitral valve or its supporting structures, which include the mitral leaflets, chordae tendineae, annulus, and papillary muscles.Etiology and Mechanisms:Primary Mitral Regurgitation: This type arises from...
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Diversity, equity, and inclusion in arrhythmia care: a European Heart Rhythm Association survey.

Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology·2026
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Related Experiment Video

Updated: Jan 11, 2026

Translational Rabbit Model of Chronic Cardiac Pacing
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Comparing Conduction System Pacing to Biventricular Upgrade in Pacemaker-Induced Cardiomyopathy: A Retrospective

Bernadett Miriam Dobai1,2, Balázs Polgár3, Márk Gémesi3,4

  • 1Doctoral School of Medicine and Pharmacy, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540139 Targu Mures, Romania.

Journal of Clinical Medicine
|November 13, 2025
PubMed
Summary

Conduction system pacing (CSP) offers a feasible and cost-efficient alternative to biventricular (BIV) upgrade for patients with pacemaker-induced cardiomyopathy (PICM). Both methods improved cardiac function and outcomes, with CSP showing potential economic benefits.

Keywords:
biventricular pacingcardiac resynchronization therapyconduction system pacingheart failurehis-bundle pacingleft bundle branch area pacingpacemaker-induced cardiomyopathyupgrade procedure

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Area of Science:

  • Cardiology
  • Electrophysiology
  • Medical Device Technology

Background:

  • Pacemaker-induced cardiomyopathy (PICM) affects up to 30% of patients with chronic right ventricular pacing.
  • Biventricular (BIV) upgrade is the standard treatment, but conduction system pacing (CSP) is a newer, physiologic alternative.
  • Comparative data on CSP versus BIV upgrade in PICM patients is limited.

Purpose of the Study:

  • To compare the clinical outcomes of PICM patients undergoing CSP versus BIV upgrade.
  • To evaluate the efficacy and feasibility of CSP as an alternative to BIV upgrade in PICM.
  • To assess procedural, echocardiographic, and quality of life parameters in both groups.

Main Methods:

  • Retrospective analysis of 63 consecutive PICM patients upgraded to CSP (n=26) or BIV (n=37) between 2022-2024.
  • Follow-up averaged over 19 months, evaluating clinical outcomes, lead performance, echocardiographic parameters, complications, and quality of life (QoL).
  • Comparison of baseline characteristics, procedural data (duration, fluoroscopy), QRS duration, left ventricular ejection fraction (LVEF), and NYHA class.

Main Results:

  • Both CSP and BIV groups showed significant QRS narrowing and LVEF improvement during follow-up.
  • No significant differences were observed between CSP and BIV in heart failure hospitalizations, mortality, or QoL.
  • CSP demonstrated potential economic benefits, with 34.6% of patients retaining their existing generator.

Conclusions:

  • Conduction system pacing (CSP) is a feasible and potentially cost-efficient alternative to biventricular (BIV) upgrade for PICM.
  • CSP achieves comparable improvements in ventricular function, symptoms, and clinical outcomes to BIV upgrade.
  • Larger prospective trials are warranted to further validate these findings.