Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Apr 26;25(Suppl C):C227-C233.
doi: 10.1093/eurheartjsupp/suad046. eCollection 2023 May.

Cardiac resynchronization therapy: present and future

Marco Schiavone  1   2 , Roberto Arosio  1 , Simone Valenza  1 , Diego Ruggiero  1 , Gianfranco Mitacchione  1 , Leonida Lombardi  1 , Maurizio Viecca  1 , Giovanni Battista Forleo  1
Affiliations

Cardiac resynchronization therapy: present and future

Marco Schiavone et al. Eur Heart J Suppl. .

Abstract

Cardiac resynchronization therapy (CRT) via biventricular pacing (BVP) is a well-established therapy for patients with heart failure with reduced ejection fraction and left bundle branch block, who remain symptomatic despite optimal medical therapy. Despite the long-standing clinical evidence, as well as the familiarity of cardiac electrophysiologists with the implantation technique, CRT via BVP cannot be achieved or may result ineffective in up to one-third of the patients. Therefore, new alternative techniques, such as conduction system pacing and left ventricular pacing, are emerging as potential alternatives to this technique, not only in case of BVP failure, but also as a stand-alone first choice due to several potential advantages over traditional CRT. Specifically, due to its procedural characteristics, left bundle branch area pacing appears to be the most convincing technique, showing comparable efficacy outcomes when compared with traditional CRT, not increasing short-term device-related complications, as well as improving procedural times. However, transvenous leads remain a major limitation of all these pacing modalities. To overcome this limit, a leadless left ventricular endocardial pacing has been developed as an additional tool to achieve a left endocardial activation, although being still associated with non-negligible pitfalls, limiting its current use in clinical practice. This article focuses on the current state and latest progresses in cardiac resynchronization therapy.

Keywords: Biventricular pacing; Cardiac resynchronization therapy; Conduction system pacing; His-bundle pacing; Left bundle branch area pacing; Left ventricular pacing.

PubMed Disclaimer

Conflict of interest statement

Conflict of interest: None declared.

Figures

Figure 1
Figure 1
Novel pacing approaches for cardiac resynchronization therapy. New alternative techniques to conventional biventricular cardiac resynchronization therapy include conduction system pacing, such as His-bundle pacing and left bundle branch pacing (main trunk or fascicular branches), and left ventricular pacing, encompassing left ventricular septal pacing and left ventricular endocardial pacing. Left bundle branch pacing and left ventricular septal pacing fall into the left bundle branch area pacing.
Figure 2
Figure 2
Left bundle area pacing in left bundle branch block patients: target zones.
See this image and copyright information in PMC

References

    1. McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M et al. . 2021 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2021;42:3599–3726. - PubMed
    1. Linde C, Abraham WT, Gold MR, St. John Sutton M, Ghio S, Daubert C. Randomized trial of cardiac resynchronization in mildly symptomatic heart failure patients and in asymptomatic patients with left ventricular dysfunction and previous heart failure symptoms. J Am Coll Cardiol 2008;52:1834–1843. - PubMed
    1. Ypenburg C, van Bommel RJ, Borleffs CJW, Bleeker GB, Boersma E, Schalij MJ et al. . Long-Term prognosis after cardiac resynchronization therapy is related to the extent of left ventricular reverse remodeling at midterm follow-up. J Am Coll Cardiol 2009;53:483–490. - PubMed
    1. Cunnington C, Kwok CS, Satchithananda DK, Patwala A, Khan MA, Zaidi A et al. . Cardiac resynchronisation therapy is not associated with a reduction in mortality or heart failure hospitalisation in patients with non-left bundle branch block QRS morphology: meta-analysis of randomised controlled trials. Heart 2015;101:1456–1462. - PubMed
    1. Patel D, Kumar A, Black-Maier E, Morgan RL, Trulock K, Wilner B et al. . Cardiac resynchronization therapy with or without defibrillation in patients with nonischemic cardiomyopathy: a systematic review and meta-analysis. Circ Arrhythm Electrophysiol 2021;14:e008991. - PubMed