Artículos de revistas: "Resynchronization technique"

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Semeniuk, O. I., M. S. Sorokivskyy, U. P. Chernyaha-Royko, B. B. Kravchuk y O. J. Zharinov. "Методи ресинхронізаційної терапії в пацієнтів із серцевою недостатністю і порушеннями внутрішньошлуночкової провідності". Ukrainian Journal of Cardiology 32, n.º 2 (28 de abril de 2025): 54–66. https://doi.org/10.31928/2664-4479-2025.2.5466.

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Cardiac resynchronization therapy is an effective treatment method for patients with intraventricular conduction disturbances combined with heart failure and left ventricular systolic dysfunction. The mechanism of resynchronization therapy lies in restoring atrioventricular, intraventricular, and interventricular synchrony, which leads to coordinated ventricular function and improvement in ventricular systolic performance. There are two main methods of resynchronization therapy: biventricular pacing and conduction system pacing. Significant attention is being devoted to conduction system pacing, a relatively new technique that has shown promising results. By many criteria, conduction system pacing, particularly left bundle branch pacing, even surpasses biventricular pacing, which may significantly increase its importance in the near future. In some cases, to achieve better resynchronization effect, methods for resynchronization therapy optimization have been used. These methods involve simultaneous pacing in different loci, as well as the combination of biventricular pacing and conduction system pacing (LOT-CRT, HOT-CRT). This review analyzes the clinical aspects and features of both techniques, along with the advantages and disadvantages of each resynchronization approach.

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Schiavone, Marco, Roberto Arosio, Simone Valenza, Diego Ruggiero, Gianfranco Mitacchione, Leonida Lombardi, Maurizio Viecca y Giovanni Battista Forleo. "Cardiac resynchronization therapy: present and future". European Heart Journal Supplements 25, Supplement_C (26 de abril de 2023): C227—C233. http://dx.doi.org/10.1093/eurheartjsupp/suad046.

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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.

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Pradip Kumar Ghoshal, Subhraprakash Pramanik, Tanmoy Kanti Goswami, Rajarshi Mondal, Arunava Biswas y Asish Biswas. "Dual versus conventional cardiac resynchronization: A pilot study". Asian Journal of Medical Sciences 15, n.º 7 (1 de julio de 2024): 68–73. https://doi.org/10.71152/ajms.v15i7.4086.

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Background: Systolic heart failure treatment now includes cardiac resynchronization therapy (CRT) as a necessary element. CRT has been shown to have advantageous impacts on mortality, hospitalization rates, and quality of life. Approximately 30% of patients fail to respond to traditional CRT implantation. Aims and Objectives: This study aimed to compare the outcome of dual resynchronization by placing the right ventricular pacing lead at His bundle or left bundle branch area against conventional CRT. Materials and Methods: This longitudinal follow-up study of a total of 35 patients undergoing CRT device placement for assessment of safety, efficacy, and feasibility of the procedure and post-procedural complications and correlation with parameters obtained from electrocardiogram and echocardiography parameters in a tertiary care set up in India. Results: Among this matched population (mean age 64 years) there was a higher responder rate with the newer technique of dual resynchronization compared to conventional CRT (83% vs. 70%). Conclusion: Dual resynchronization therapy is feasible and safe and provides better electrical resynchronization compared to conventional CRT and could be a better alternative, especially when suboptimal electrical resynchronization is obtained.

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Pradip Kumar Ghoshal, Subhraprakash Pramanik, Tanmoy Kanti Goswami, Rajarshi Mondal, Arunava Biswas y Asish Biswas. "Dual versus conventional cardiac resynchronization: A pilot study". Asian Journal of Medical Sciences 15, n.º 7 (1 de julio de 2024): 68–73. http://dx.doi.org/10.3126/ajms.v15i7.65304.

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Background: Systolic heart failure treatment now includes cardiac resynchronization therapy (CRT) as a necessary element. CRT has been shown to have advantageous impacts on mortality, hospitalization rates, and quality of life. Approximately 30% of patients fail to respond to traditional CRT implantation. Aims and Objectives: This study aimed to compare the outcome of dual resynchronization by placing the right ventricular pacing lead at His bundle or left bundle branch area against conventional CRT. Materials and Methods: This longitudinal follow-up study of a total of 35 patients undergoing CRT device placement for assessment of safety, efficacy, and feasibility of the procedure and post-procedural complications and correlation with parameters obtained from electrocardiogram and echocardiography parameters in a tertiary care set up in India. Results: Among this matched population (mean age 64 years) there was a higher responder rate with the newer technique of dual resynchronization compared to conventional CRT (83% vs. 70%). Conclusion: Dual resynchronization therapy is feasible and safe and provides better electrical resynchronization compared to conventional CRT and could be a better alternative, especially when suboptimal electrical resynchronization is obtained.

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Droghetti, A., M. C. Bottoli, M. Ragusa, P. Pepi, M. Giovanardi, A. Reggiani, D. Pozzetti, M. Malacrida, A. Colombo y G. Muriana. "Minimally invasive thoracoscopic technique for cardiac resynchronization therapy". Multimedia Manual of Cardio-Thoracic Surgery 2015 (17 de junio de 2015): mmv008. http://dx.doi.org/10.1093/mmcts/mmv008.

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Maass, Alexander H., Fenna Daniëls, Eva Roseboom, Kevin Vernooy y Michiel Rienstra. "Special Issue: Latest Advances in Delivery and Outcomes of Cardiac Resynchronization Therapy and Conduction System Pacing". Journal of Clinical Medicine 12, n.º 10 (14 de mayo de 2023): 3453. http://dx.doi.org/10.3390/jcm12103453.

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Imnadze, Guram, Khaled Awad, Wolfgang Kranig y Irakli Giorgberidze. "Modified Pull-Through Technique for Cardiac Resynchronization Therapy Upgrades in Patients with Occluded Access Veins". Texas Heart Institute Journal 47, n.º 1 (1 de febrero de 2020): 23–26. http://dx.doi.org/10.14503/thij-18-6713.

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The number of procedures for upgrading implantable devices for cardiac resynchronization therapy has increased considerably during the last decade. A major challenge that operators face in these circumstances is occlusion of the access vein. We have modified a pull-through method to overcome this obstacle. Six consecutive patients with occluded access veins and well-developed collateral networks underwent a procedure in which the occluded vein was recanalized by snaring the existing atrial lead via transfemoral access. Upgrading the device was successful in all patients; none had intraprocedural complications. Our experience shows that our modified pull-through technique may be a feasible alternative for upgrading cardiac resynchronization therapy in patients with venous occlusion.

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Chan, Ngai Yin y Ying Keung Lo. "Impacted left ventricular lead technique in cardiac resynchronization therapy". EP Europace 9, n.º 7 (23 de mayo de 2007): 531–32. http://dx.doi.org/10.1093/europace/eum084.

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Lu, Wei-Da y Ju-Yi Chen. "Proposed treatment algorithm for cardiac device-related subclavian vein stenosis: a case series". European Heart Journal - Case Reports 4, n.º 1 (20 de enero de 2020): 1–6. http://dx.doi.org/10.1093/ehjcr/ytz245.

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Abstract Background Subclavian vein obstruction may occur in patients with pacemaker leads, which may make the implantation of new pacemaker leads difficult. Case summary We report two cases in which upgrading to cardiac resynchronization therapy pacemaker was challenging due to total central vein occlusion. In the first case, a 78-year-old woman with permanent pacemaker implantation, 5 years ago, was successfully treated by balloon venoplasty. In the second case, balloon venoplasty was unsuccessful in a 46-year-old woman who has received twice single-chamber implantable cardioverter-defibrillator, 12 years and 5 years ago, due to vessel crowding, so a contralateral side puncture, along with a tunnel technique, was performed to solve this problem. Discussion Cardiac implantable electronic device-related subclavian vein stenosis can present a challenge to common cardiac resynchronization therapy device upgrades in the absence of appropriate techniques.

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Karki, Saurab, Pallavi Lakra, Kaushik Kumar y Shiavax J. Rao. "Conduction System Pacing for Cardiac Resynchronization Therapy in Heart Failure with Reduced Ejection Fraction". Journal of Clinical Medicine 14, n.º 3 (30 de enero de 2025): 917. https://doi.org/10.3390/jcm14030917.

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Most patients with heart failure exhibit ventricular dyssynchrony, which is addressed by cardiac resynchronization therapy, traditionally through the use of biventricular pacing (BVP) devices. Despite this, around 30% of patients do not achieve the desired clinical outcome, and echocardiographic findings show that some patients deteriorate even further. Conduction system pacing (CSP) is a more physiologic pacing technique and includes his-bundle pacing (HBP) and left bundle branch area pacing (LBBAP). In this review, we further discuss and compare various CSP techniques for cardiac resynchronization therapy in patients with heart failure with reduced ejection fraction. After analyzing the current state of the literature on this topic until 2023, eight studies were included in this review and consisted of two trials and five observational studies with a total of 2841 patients. Both BVP and CSP resulted in improved outcomes in terms of NYHA class, QRS duration, and left ventricular ejection fraction over time. These effects were more pronounced in patients undergoing CSP, as the technique is more physiological and results in the synchronized activation of the ventricles. LBBAP yielded better outcomes compared to BVP and resulted in fewer heart failure hospitalizations and a lower all-cause mortality rate.

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SAKSENA, SANJEEV, ANN MARIE SIMON, PHILIP MATHEW y RANGADHAM NAGARAKANTI. "Intracardiac Echocardiography-Guided Cardiac Resynchronization Therapy: Technique and Clinical Application". Pacing and Clinical Electrophysiology 32, n.º 8 (17 de julio de 2009): 1030–39. http://dx.doi.org/10.1111/j.1540-8159.2009.02435.x.

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Hofer, Daniel y Alexander Breitenstein. "Snare technique for coronary sinus cannulation in cardiac resynchronization therapy". Indian Pacing and Electrophysiology Journal 20, n.º 6 (noviembre de 2020): 293–95. http://dx.doi.org/10.1016/j.ipej.2020.09.004.

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Șoșdean, Raluca, S. Pescariu, B. Enache, Ri Macarie y Raluca Marca. "Implantation of Biventricular Cardiac Devices Using a Double Venous Approach — An Alternative Implantation Technique". Acta Medica Marisiensis 60, n.º 2 (1 de abril de 2014): 57–60. http://dx.doi.org/10.2478/amma-2014-0013.

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Abstract Background: A standard technique regarding venous approach for implantation of biventricular cardiac electrical devices used for cardiac resynchronization therapy implementation has not yet been established. We analyzed the safety and efficiency of implanting these devices using a double venous approach (cephalic and subclavian) by comparing it with the simple approaches, in order to overcome some of their inconvenients. Materials and methods: We retrospectively analyzed all 228 resynchronization patients implanted at the Timișoara Institute of Cardiovascular Medicine between January 1st, 2000 and January 1st, 2013. The 204 patients successfully implanted with biventricular pacemakers or defibrillators were divided according to the implantation techniques, and compared by complication rates and values of acute stimulationdetection thresholds. Group A featured a subclavian approach (48 patients), group B a cephalic approach (81 patients) and group C a double venous approach (76 patients). Results: Adjusting for age, sex and device type there is no evidence in the data that complication rates are significantly different when using the different techniques: 6 complications (12.5%) in group A, 8 (9.87%) in group B and 5 (6.75%) in group C (p = 0.51). A slight downward trend was observed by using double venous approach. Values of acute stimulation-detection thresholds had no statistically significant differences neither (p = 0.36). Cephalic vein was of high quality in 59.8% of cases. Conclusions: Subclavian and cephalic double venous approach implantation technique for biventricular devices proved to be feasible and at least as safe as single venous approach using subclavian or cephalic vein alone, and it can be used as a first resort technique.

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Ali, Nadine, Mathew Shun Shin y Zachary Whinnett. "The Emerging Role of Cardiac Conduction System Pacing as a Treatment for Heart Failure". Current Heart Failure Reports 17, n.º 5 (28 de agosto de 2020): 288–98. http://dx.doi.org/10.1007/s11897-020-00474-y.

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Abstract Purpose of Review The aim of cardiac resynchronization therapy (CRT) is to improve cardiac function by delivering more physiological cardiac activation to patients with heart failure and conduction abnormalities. Biventricular pacing (BVP) is the most commonly used method for delivering CRT; it has been shown in large randomized controlled trials to significantly improve morbidity and mortality in patients with heart failure. However, BVP delivers only modest reductions in ventricular activation time and is only beneficial in patients with prolonged QRS duration. In this review, we explore conduction system pacing as a method for delivering more effective ventricular resynchronization and to extend pacing therapy for heart failure to patients without left bundle branch block (LBBB). Recent Findings The aim of conduction system pacing is to provide physiological ventricular activation by directly stimulating the conduction system. Current modalities include His bundle and left conduction system pacing. His bundle pacing is the most established method; it has the potential to correct left bundle branch block and deliver more effective ventricular resynchronization than BVP. This translates into greater acute haemodynamic improvements and observational data suggests that His-CRT results in improvements in cardiac function and symptoms. AV-optimized His bundle pacing is being investigated in patients with heart failure and long PR interval without LBBB, to see if this improves exercise capacity. More recently, a technique for pacing the left bundle branch has been developed. Early studies show potential advantages including low and stable capture thresholds. Summary Conduction system pacing can deliver more effective ventricular resynchronization than BVP, which has the potential to deliver greater improvements in cardiac function. It may also provide the opportunity to extend pacing therapy for heart failure to patients who do not have LBBB. Further data is required from randomized trials to assess these promising pacing techniques.

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Dong, Mengya, Chenyuan Liang y Gong Cheng. "The Loop Technique in Cardiac Resynchronization Therapy: A Prospective Cohort Study". International Journal of General Medicine Volume 17 (agosto de 2024): 3711–17. http://dx.doi.org/10.2147/ijgm.s482227.

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Stepanova, Vera V., Valery A. Marinin y Stepan V. Zubarev. "Preoperative Prediction of Optimal Method and Site of Left Ventricular Electrode Implantation". Cardiac Arrhythmias 2, n.º 2 (25 de septiembre de 2022): 51–56. http://dx.doi.org/10.17816/cardar108644.

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We present a clinical case of cardiac resynchronization device implantation in a patient with a zone of late left ventricular activation in the area of the anterior coronary sinus vein, which, however, was unsuitable for endovascular implantation and stable electrode placement in it. This anatomical feature was diagnosed at the outpatient stage using a noninvasive mapping technique. Using this approach, we were able to understand that an epicardial electrode implantation, instead of traditional endovascular implantation of the left ventricular electrode through the coronary sinus vein, is indicated for the patient. Targeted implantation of an epicardial electrode in the area of interest on the epicardial surface of the left ventricle in the basal part of the anterolateral wall allowed achieving a complete clinical response to resynchronization therapy.

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Bălţat, Georgiana, Ioan Maniţiu, Monica Yepez Benavides, Cornel Ioan Bitea, Denisa Dincă, Gabriela Eminovici y Minodora Teodoru. "The Role of Cardiac Magnetic Resonance in Patients with Dilated Cardiomiopathy". Acta Medica Transilvanica 26, n.º 2 (1 de junio de 2021): 26–29. http://dx.doi.org/10.2478/amtsb-2021-0028.

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Abstract Dilated cardiomyopathy (DCM) has an increased risk of heart failure, malignant ventricular arrhythmias, including sudden cardiac death, being the most common cause of heart transplantation. Cardiac magnetic resonance imaging (CMR) is the gold standard technique for assessing left and right ventricular function; the major advantage of CMR is the possibility of tissue characterization, highlighting the replacement of myocardial fibrosis (late gadolinium enhancement - LGE technique) and the interstitial and perivascular reactive fibrosis (mapping techniques - T1 mapping, T2-mapping, T2 * -mapping). Myocardial fibrosis pattern helps to establish the DCM aetiology and has prognostic and therapeutic implications. LGE presence is associated with a weaker therapeutic response and an increased risk of complex ventricular arrhythmias. At the same time, LGE absence associated with the presence of reactive fibrosis quantified by mapping techniques and especially by increasing myocardial extracellular volume, identifies patients with potentially favourable response to optimal drug therapy and cardiac resynchronization therapy.

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Kim, Juwon, Sung Ho Lee, Hye Ree Kim, Tae-Wan Chung, Ji-Hoon Choi, Ju Youn Kim, Kyoung-Min Park, Young Keun On, June Soo Kim y Seung-Jung Park. "Orthodromic and Antidromic Snare Techniques for Left Ventricular Lead Implantation in Cardiac Resynchronization Therapy". Journal of Clinical Medicine 11, n.º 8 (11 de abril de 2022): 2133. http://dx.doi.org/10.3390/jcm11082133.

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The snare technique can be used to overcome unsuitable cardiac venous anatomies for left ventricular (LV) lead implantation in cardiac resynchronization therapy (CRT) procedures. However, limited data exist regarding performance of the snare technique. We classified 262 patients undergoing CRT procedure into the snare (n = 20) or conventional group (n = 242) according to the LV lead implantation method. We compared the safety, efficacy, and composite outcome (all-cause death and heart failure readmission) at 3 years post-implant between the snare and conventional groups. In the snare group, all LV leads were implanted safely using orthodromic (n = 15) or antidromic (n = 5) techniques, and no immediate complications occurred including vessel perforation, tamponade, and lead dislodgement. During follow-up, LV lead threshold and impedance remained stable without requiring lead revision in the snare group. There were no significant between-group differences regarding LV ejection fraction increase (12 ± 13% vs. 12 ± 13%, p = 0.929) and LV end-systolic volume reduction (18 ± 48% vs. 28 ± 31%, p = 0.501). Both groups exhibited comparable CRT-response rates (62.5% vs. 60.6%, p = 1.000). The risk of primary outcome was not significantly different between the two groups (25.9% vs. 30.9%, p = 0.817). In patients who failed conventional LV lead implantation for CRT, the snare technique could be a safe and effective solution to overcome difficult coronary venous anatomy.

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Denysiuk, Piotr, Marcin Szczasny, Tomasz Chromiński y Ryszard Grzywna. "Cardiac resynchronization therapy – ICD-VR upgrade after transcatheter aortic valve implantation". In a good rythm 1, n.º 46 (22 de marzo de 2018): 40–42. http://dx.doi.org/10.5604/01.3001.0011.6499.

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Transcatheter aortic valve implantation (TAVI) procedure is often complicated by left bundle branch block – mostly associated with the vicinity of the conduction system and the procedure's technique itself. In patients with coexisting advanced heart failure that suffered from this complication cardiac resynchronization therapy may be the right choice. We report first (to the best of our knowledge) case of a patient after TAVI that benefited significantly from an ICD to CRT-D upgrade.

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Marques, Pedro, Afonso Nunes‐Ferreira, Pedro S. António, Inês Aguiar‐Ricardo, Gustavo Lima da Silva, Tatiana Guimarães, Ana Bernardes, Igor Santos, Fausto J. Pinto y João Sousa. "Modified snare technique improves left ventricular lead implant success for cardiac resynchronization therapy". Journal of Cardiovascular Electrophysiology 31, n.º 11 (28 de septiembre de 2020): 2954–63. http://dx.doi.org/10.1111/jce.14750.

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Reddy, Muni Venkatesa, Saurabh Ajit Deshpande, Shishir Kumar Roul y Ameya Udyavar. "Successful use of venovenous snare to fix the wire in a collateral vein for proper placement of the left ventricular lead during cardiac resynchronization therapy: a case report". European Heart Journal - Case Reports 4, n.º 4 (26 de mayo de 2020): 1–7. http://dx.doi.org/10.1093/ehjcr/ytaa114.

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Abstract Background In cardiac resynchronization therapy, left ventricular (LV) lead placement at the desired position may be difficult due to abnormal coronary sinus (CS) and lateral vein anatomy. We present a case with difficult anatomy in which we used ‘an indigenous snare’ made from hardware used for coronary angioplasty procedures, which is available in any cardiac catheterization laboratory. Case summary A 52-year-old man presented with dyspnoea due to chronic heart failure was evaluated for cardiac resynchronization therapy. The LV lead was difficult to advance into the only target lateral branch of the CS due to a combination of angulation and proximal stenosis. Balloon dilation was tried first, but we failed to track the LV lead. We formed a venovenous loop, advancing the coronary guidewire 0.014″ into the posterolateral vein; subsequently into the middle cardiac vein via a collateral. The wire was advanced into the CS and then to superior vena cava. The guidewire then snared through the same left subclavian vein and exteriorized by using indigenous snare. Over this loop, the LV lead of the cardiac resynchronization therapy with defibrillator device was implanted successfully. Discussion We have used the snare technique, with the use of a snare prepared from a coronary guidewire. Use of such an indigenous snare has not been described before in the literature. The hardware used in this case is routinely used for coronary angioplasty procedures in all catheterization labs. The importance of our case is that no special hardware like dedicated snare was required to negotiate the LV lead at its desired location.

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CHIERCHIA, GIAN-BATTISTA, PETER GEELEN, MAXIMO RIVERO-AYERZA y PEDRO BRUGADA. "Double Wire Technique to Catheterize Sharply Angulated Coronary Sinus Branches in Cardiac Resynchronization Therapy". Pacing and Clinical Electrophysiology 28, n.º 2 (febrero de 2005): 168–70. http://dx.doi.org/10.1111/j.1540-8159.2005.04037.x.

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Katritsis, D. G. "A novel technique for placement of coronary sinus pacing leads in cardiac resynchronization therapy". Europace 9, n.º 10 (8 de junio de 2007): 878–79. http://dx.doi.org/10.1093/europace/eum146.

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Liang, Yixiu, Daxin Zhou, Jingfeng Wang, Shengmei Qin, Xueying Chen, Yangang Su y Junbo Ge. "Atrial transseptal left ventricular lead implantation for cardiac resynchronization therapy using arteriovenous loop technique". Pacing and Clinical Electrophysiology 41, n.º 7 (30 de abril de 2018): 866–69. http://dx.doi.org/10.1111/pace.13323.

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Braun, Martin U., Andreas Schnabel, Thomas Rauwolf, Matthias Schulze y Ruth H. Strasser. "Impedance Cardiography as a Noninvasive Technique for Atrioventricular Interval Optimization in Cardiac Resynchronization Therapy". Journal of Interventional Cardiac Electrophysiology 13, n.º 3 (septiembre de 2005): 223–29. http://dx.doi.org/10.1007/s10840-005-2361-z.

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Haschemi, C. y M. Heinke. "Atrial and ventricular signal averaging electrocardiography in pacemaker and cardiac resynchronization therapy". Current Directions in Biomedical Engineering 1, n.º 1 (1 de septiembre de 2015): 58–60. http://dx.doi.org/10.1515/cdbme-2015-0015.

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AbstractCardiac resynchronization therapy with atrioventricular and interventricular delay optimized biventricular pacing is an established therapy for symptomatic heart failure patients with prolongation of QRS duration, left bundle branch block and reduced left ventricular ejection fraction. The aim of the investigation was to evaluate right atrial, right ventricular and left ventricular electrical signals of implantable electronic cardiac devices with and without signal averaging technique with novel LabVIEW software. Electrical interatrial conduction delay and inter-ventricular conduction delay may be useful parameters to evaluate electrical atrial and ventricular desynchronization in heart failure patients.

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Pereira, Helder, Steven Niederer y Christopher A. Rinaldi. "Electrocardiographic imaging for cardiac arrhythmias and resynchronization therapy". EP Europace 22, n.º 10 (5 de agosto de 2020): 1447–62. http://dx.doi.org/10.1093/europace/euaa165.

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Abstract Use of the 12-lead electrocardiogram (ECG) is fundamental for the assessment of heart disease, including arrhythmias, but cannot always reveal the underlying mechanism or the location of the arrhythmia origin. Electrocardiographic imaging (ECGi) is a non-invasive multi-lead ECG-type imaging tool that enhances conventional 12-lead ECG. Although it is an established technology, its continuous development has been shown to assist in arrhythmic activation mapping and provide insights into the mechanism of cardiac resynchronization therapy (CRT). This review addresses the validity, reliability, and overall feasibility of ECGi for use in a diverse range of arrhythmias. A systematic search limited to full-text human studies published in peer-reviewed journals was performed through Medline via PubMed, using various combinations of three key concepts: ECGi, arrhythmia, and CRT. A total of 456 studies were screened through titles and abstracts. Ultimately, 42 studies were included for literature review. Evidence to date suggests that ECGi can be used to provide diagnostic insights regarding the mechanistic basis of arrhythmias and the location of arrhythmia origin. Furthermore, ECGi can yield valuable information to guide therapeutic decision-making, including during CRT. Several studies have used ECGi as a diagnostic tool for atrial and ventricular arrhythmias. More recently, studies have tested the value of this technique in predicting outcomes of CRT. As a non-invasive method for assessing cardiovascular disease, particularly arrhythmias, ECGi represents a significant advancement over standard procedures in contemporary cardiology. Its full potential has yet to be fully explored.

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Burri, Haran, Marek Jastrzebski, Óscar Cano, Karol Čurila, Jan de Pooter, Weijian Huang, Carsten Israel et al. "EHRA clinical consensus statement on conduction system pacing implantation: endorsed by the Asia Pacific Heart Rhythm Society (APHRS), Canadian Heart Rhythm Society (CHRS), and Latin American Heart Rhythm Society (LAHRS)". EP Europace 25, n.º 4 (15 de abril de 2023): 1208–36. http://dx.doi.org/10.1093/europace/euad043.

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Abstract Conduction system pacing (CSP) has emerged as a more physiological alternative to right ventricular pacing and is also being used in selected cases for cardiac resynchronization therapy. His bundle pacing was first introduced over two decades ago and its use has risen over the last five years with the advent of tools which have facilitated implantation. Left bundle branch area pacing is more recent but its adoption is growing fast due to a wider target area and excellent electrical parameters. Nevertheless, as with any intervention, proper technique is a prerequisite for safe and effective delivery of therapy. This document aims to standardize the procedure and to provide a framework for physicians who wish to start CSP implantation, or who wish to improve their technique.

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Feng, Xiang-Fei, Rui Zhang, Mei Yang, Bo Liu, Ya-Qin Han, Qiu-Fen Lu y Yi-Gang Li. "A technique for cardiac resynchronization therapy using left bundle branch area and left ventricular pacing". Chinese Medical Journal 134, n.º 22 (7 de octubre de 2021): 2744–46. http://dx.doi.org/10.1097/cm9.0000000000001622.

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MEADE, THOMAS H. y J. ALBERTO LOPEZ. "Balloon Occlusion Technique to Cannulate Angulated and Tortuous Coronary Sinus Branches in Cardiac Resynchronization Therapy". Pacing and Clinical Electrophysiology 28, n.º 11 (noviembre de 2005): 1243–44. http://dx.doi.org/10.1111/j.1540-8159.2005.50212.x.

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Edgerton, James R., Zachary J. Edgerton, Michael J. Mack, Shannon Hoffman, Todd M. Dewey y Morley A. Herbert. "Ventricular Epicardial Lead Placement for Resynchronization by Determination of Paced Depolarization Intervals: Technique and Rationale". Annals of Thoracic Surgery 83, n.º 1 (enero de 2007): 89–92. http://dx.doi.org/10.1016/j.athoracsur.2006.08.048.

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Mele, Donato. "Speckle Tracking Echocardiography for Cardiac Resynchronization Therapy: Has the Right Ultrasound Technique Finally Been Found?" Journal of the American Society of Echocardiography 23, n.º 2 (febrero de 2010): 190–94. http://dx.doi.org/10.1016/j.echo.2009.12.025.

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Romeyer-Bouchard, Cécile, Antoine Da Costa, Loucif Abdellaoui, Marc Messier, Jérôme Thévenin, Zahi Afif, Bernard Samuel et al. "Simplified cardiac resynchronization implantation technique involving right access and a triple-guide/single introducer approach". Heart Rhythm 2, n.º 7 (julio de 2005): 714–19. http://dx.doi.org/10.1016/j.hrthm.2005.04.005.

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34

Spragg, David. "An echocardiography-based technique for screening cardiac resynchronization therapy patients: Déjà vu all over again?" Heart Rhythm 7, n.º 11 (noviembre de 2010): 1587–88. http://dx.doi.org/10.1016/j.hrthm.2010.07.012.

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35

Sperlongano, Simona, Antonello D’Andrea, Donato Mele, Vincenzo Russo, Valeria Pergola, Andreina Carbone, Federica Ilardi et al. "Left Ventricular Deformation and Vortex Analysis in Heart Failure: From Ultrasound Technique to Current Clinical Application". Diagnostics 11, n.º 5 (17 de mayo de 2021): 892. http://dx.doi.org/10.3390/diagnostics11050892.

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Heart failure (HF) is a leading cause of cardiovascular morbidity and mortality. However, its symptoms and signs are not specific or can be absent. In this context, transthoracic echocardiography plays a key role in diagnosing the various forms of HF, guiding therapeutic decision making and monitoring response to therapy. Over the last few decades, new ultrasound modalities have been introduced in the field of echocardiography, aiming at better understanding the morpho-functional abnormalities occurring in cardiovascular diseases. However, they are still struggling to enter daily and routine use. In our review article, we turn the spotlight on some of the newest ultrasound technologies; in particular, analysis of myocardial deformation by speckle tracking echocardiography, and intracardiac flow dynamics by color Doppler flow mapping, highlighting their promising applications to HF diagnosis and management. We also focus on the importance of these imaging modalities in the selection of responses to cardiac resynchronization therapy.

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Orszulak, Michał, Artur Filipecki, Wojciech Wróbel, Adrianna Berger-Kucza, Witold Orszulak, Dagmara Urbańczyk-Swić, Wojciech Kwaśniewski, Edyta Płońska-Gościniak y Katarzyna Mizia-Stec. "Regional Strain Pattern Index—A Novel Technique to Predict CRT Response". International Journal of Environmental Research and Public Health 18, n.º 3 (21 de enero de 2021): 926. http://dx.doi.org/10.3390/ijerph18030926.

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Background: Cardiac resynchronization therapy (CRT) improves outcome in patients with heart failure (HF) however approximately 30% of patients still remain non-responsive. We propose a novel index—Regional Strain Pattern Index (RSPI)—to prospectively evaluate response to CRT. Methods: Echocardiography was performed in 49 patients with HF (66.5 ± 10 years, LVEF 24.9 ± 6.4%, QRS width 173.1 ± 19.1 ms) two times: before CRT implantation and 15 ± 7 months after. At baseline, dyssynchrony was assessed including RSPI and strain pattern. RSPI was calculated from all three apical views across 12 segments as the sum of dyssynchronous components. From every apical view, presence of four components were assessed: (1) contraction of the early-activated wall; (2) prestretching of the late activated wall; (3) contraction of the early-activated wall in the first 70% of the systolic ejection phase; (4) peak contraction of the late-activated wall after aortic valve closure. Each component scored 1 point, thus the maximum was 12 points. Results: Responders reached higher mean RSPI values than non-responders (5.86 ± 2.9 vs. 4.08 ± 2.4; p = 0.044). In logistic regression analysis value of RSPI ≥ 7 points was a predictor of favorable CRT effect (OR: 12; 95% CI = 1.33–108.17; p = 0.004). Conclusions: RSPI could be a valuable predictor of positive outcome in HF patients treated with CRT.

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Castagno, Davide, Francesco Zanon, Gianni Pastore, Gaetano Maria De Ferrari y Lina Marcantoni. "Is Conduction System Pacing a Valuable Alternative to Biventricular Pacing for Cardiac Resynchronization Therapy?" Journal of Cardiovascular Development and Disease 11, n.º 5 (2 de mayo de 2024): 144. http://dx.doi.org/10.3390/jcdd11050144.

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Cardiac resynchronization therapy (CRT) significantly improves clinical outcomes in patients with ventricular systolic dysfunction and dyssynchrony. Biventricular pacing (BVP) has a class IA recommendation for patients with symptomatic heart failure with reduced ejection fraction (HFrEF) and left bundle branch block (LBBB). However, approximately 30% of patients have a poor therapeutic response and do not achieve real clinical benefit. Pre-implant imaging, together with tailored programming and dedicated device algorithms, have been proposed as possible tools to improve success rate but have shown inconsistent results. Over the last few years, conduction system pacing (CSP) is becoming a real and attractive alternative to standard BVP as it can restore narrow QRS in patients with bundle branch block (BBB) by stimulating and recruiting the cardiac conduction system, thus ensuring true resynchronization. It includes His bundle pacing (HBP) and left bundle branch area pacing (LBBAP). Preliminary data coming from small single-center experiences are very promising and have laid the basis for currently ongoing randomized controlled trials comparing CSP with BVP. The purpose of this review is to delve into the emerging role of CSP as an alternative method of achieving CRT. After framing CSP in a historical perspective, the pathophysiological rationale and available clinical evidence will be examined, and crucial technical aspects will be discussed. Finally, evidence gaps and future perspectives on CSP as a technique of choice to deliver CRT will be summarized.

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Nguyên, Uyên Châu, Jesse H. J. Rijks, Filip Plesinger, Leonard M. Rademakers, Justin Luermans, Karin C. Smits, Antonius M. W. van Stipdonk et al. "Ultra-High-Frequency ECG in Cardiac Pacing and Cardiac Resynchronization Therapy: From Technical Concept to Clinical Application". Journal of Cardiovascular Development and Disease 11, n.º 3 (23 de febrero de 2024): 76. http://dx.doi.org/10.3390/jcdd11030076.

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Identifying electrical dyssynchrony is crucial for cardiac pacing and cardiac resynchronization therapy (CRT). The ultra-high-frequency electrocardiography (UHF-ECG) technique allows instantaneous dyssynchrony analyses with real-time visualization. This review explores the physiological background of higher frequencies in ventricular conduction and the translational evolution of UHF-ECG in cardiac pacing and CRT. Although high-frequency components were studied half a century ago, their exploration in the dyssynchrony context is rare. UHF-ECG records ECG signals from eight precordial leads over multiple beats in time. After initial conceptual studies, the implementation of an instant visualization of ventricular activation led to clinical implementation with minimal patient burden. UHF-ECG aids patient selection in biventricular CRT and evaluates ventricular activation during various forms of conduction system pacing (CSP). UHF-ECG ventricular electrical dyssynchrony has been associated with clinical outcomes in a large retrospective CRT cohort and has been used to study the electrophysiological differences between CSP methods, including His bundle pacing, left bundle branch (area) pacing, left ventricular septal pacing and conventional biventricular pacing. UHF-ECG can potentially be used to determine a tailored resynchronization approach (CRT through biventricular pacing or CSP) based on the electrical substrate (true LBBB vs. non-specified intraventricular conduction delay with more distal left ventricular conduction disease), for the optimization of CRT and holds promise beyond CRT for the risk stratification of ventricular arrhythmias.

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Woo, Gregory W., Omer L. Shedd, Naim Bouhussein, Rick D. Turek y Kelly M. Bergen. "PO-06-036 A NOVEL TECHNIQUE FOR DOWNGRADING A DF-4 / IS-4 QUADRIPOLAR LEFT VENTRICULAR LEAD CARDIAC RESYNCHRONIZATION DEFIBRILLATOR SYSTEM TO A QUADRIPOLAR CARDIAC RESYNCHRONIZATION PACEMAKER SYSTEM". Heart Rhythm 22, n.º 4 (abril de 2025): S647—S648. https://doi.org/10.1016/j.hrthm.2025.03.1584.

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Dubrovin, Oleg L. y Pavel L. Shugaev. "A successful placement of the left ventricular lead for the cardiac resynchronization device using the orthodromic snare technique: clinical case". Journal of Clinical Practice 12, n.º 3 (11 de octubre de 2021): 112–19. http://dx.doi.org/10.17816/clinpract76720.

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Background: The main aim of Cardiac Resynchronization Therapy (CRT) is a positive response of the patient, particularly, reduction of the symptoms and improvement of the heart contractility, that can be reached in 5070% of patients. The possibility of appropriate positioning the left ventricular (LV) lead is of great importance for the response to CRT. Certain instruments and technical approaches are used for the placement of the LV lead. Here, we describe the use of the orthodromic snare technique, which is quite rare in practice, but allows one to overcome some anatomical obstacles. Clinical case description: Patient A., suffering from the heart failure with a low ejection fraction and left bundle branch block, was admitted to the hospital for CRT implantation. Before the operation, all the necessary routine instrumental and laboratory diagnostics was performed. During the operation, venography of the cardiac veins revealed unsuitability of the lateral cardiac vein for the placement of the LV lead due to its very small diameter. The posterolateral vein was suitable for the LV lead implantation but still had some anatomical difficulties: an acute angle of inflow and local stenosis in the proximal segment. During the procedure, the following techniques were used without success: positioning the LV lead by a simple translational movement forward, a subselective catheter, introduction of several coronary guides in order to smooth out the acute angle of inflow. These circumstances warranted the use of the orthodromic snare technique for a successful LV lead placement. Conclusion: This clinical case illustrates the possibility of a safe and effective use of the orthodromic snare technique for LV lead implantation. Such anatomical difficulties as a small diameter, acute angle of inflow, local stenosis have also been illustrated and discussed.

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Stătescu, Cristian, Carina Ureche, Ștefana Enachi, Rodica Radu y Radu A. Sascău. "Cardiac Resynchronization Therapy in Non-Ischemic Cardiomyopathy: Role of Multimodality Imaging". Diagnostics 11, n.º 4 (30 de marzo de 2021): 625. http://dx.doi.org/10.3390/diagnostics11040625.

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Non-ischemic cardiomyopathy encompasses a heterogeneous group of diseases, with a generally unfavorable long-term prognosis. Cardiac resynchronization therapy (CRT) is a useful therapeutic option for patients with symptomatic heart failure, currently recommended by all available guidelines, with outstanding benefits, especially in non-ischemic dilated cardiomyopathy. Still, in spite of clear indications based on identifying a dyssynchronous pattern on the electrocardiogram (ECG,) a great proportion of patients are non-responders. The idea that multimodality cardiac imaging can play a role in refining the selection criteria and the implant technique and help with subsequent system optimization is promising. In this regard, predictors of CRT response, such as apical rocking and septal flash have been identified. Promising new data come from studies using cardiac magnetic resonance and nuclear imaging for showcasing myocardial dyssynchrony. Still, to date, no single imaging predictor has been included in the guidelines, probably due to lack of validation in large, multicenter cohorts. This review provides an up-to-date synthesis of the latest evidence of CRT use in non-ischemic cardiomyopathy and highlights the potential additional value of multimodality imaging for improving CRT response in this population. By incorporating all these findings into our clinical practice, we can aim toward obtaining a higher proportion of responders and improve the success rate of CRT.

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42

Burri, Haran, Marek Jastrzebski, Óscar Cano, Karol Čurila, Jan de Pooter, Weijian Huang, Carsten Israel et al. "EHRA clinical consensus statement on conduction system pacing implantation: executive summary. Endorsed by the Asia-Pacific Heart Rhythm Society (APHRS), Canadian Heart Rhythm Society (CHRS) and Latin-American Heart Rhythm Society (LAHRS)". EP Europace 25, n.º 4 (15 de abril de 2023): 1237–48. http://dx.doi.org/10.1093/europace/euad044.

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Abstract Conduction system pacing (CSP) has emerged as a more physiological alternative to right ventricular pacing and is also being used in selected cases for cardiac resynchronization therapy. His bundle pacing was first introduced over two decades ago and its use has risen over the last years with the advent of tools which have facilitated implantation. Left bundle branch area pacing is more recent but its adoption is growing fast due to a wider target area and excellent electrical parameters. Nevertheless, as with any intervention, proper technique is a prerequisite for safe and effective delivery of therapy. This document aims to standardize the procedure and to provide a framework for physicians who wish to start CSP implantation, or who wish to improve their technique. A synopsis is provided in this print edition of EP-Europace. The full document may be consulted online, and a ‘Key Messages’ App can be downloaded from the EHRA website.

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ULLAH, WAQAS, MICHAEL COOKLIN, RICHARD JAMES SALTER, TARUN SABHARWAL y CHRISTOPHER ALDO RINALDI. "Percutaneous Closure and “Push-Pull” Technique to Repair Arterial Lead and Sheath Placement Complicating Cardiac Resynchronization Therapy". Pacing and Clinical Electrophysiology 35, n.º 2 (14 de octubre de 2010): e35-e37. http://dx.doi.org/10.1111/j.1540-8159.2010.02897.x.

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44

Grubb, Christopher, Lea Melki, Daniel Y. Wang, James Peacock, Jose Dizon, Hasan Garan, Elisa Konofagou y Elaine Wan. "CARDIAC RESYNCHRONIZATION THERAPY IN 3D USING ELECTROMECHANICAL WAVE IMAGING: A NOVEL NON INVASIVE ULTRASOUND-BASED IMAGING TECHNIQUE". Journal of the American College of Cardiology 71, n.º 11 (marzo de 2018): A443. http://dx.doi.org/10.1016/s0735-1097(18)30984-7.

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45

van Gelder, Berry M., Mike G. Scheffer, Albert Meijer y Frank A. Bracke. "Transseptal endocardial left ventricular pacing: An alternative technique for coronary sinus lead placement in cardiac resynchronization therapy". Heart Rhythm 4, n.º 4 (abril de 2007): 454–60. http://dx.doi.org/10.1016/j.hrthm.2006.11.023.

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Domenichini, Giulia, Ihab Diab, Niall G. Campbell, Mehul Dhinoja, Ross J. Hunter, Simon Sporton, Mark J. Earley y Richard J. Schilling. "A highly effective technique for transseptal endocardial left ventricular lead placement for delivery of cardiac resynchronization therapy". Heart Rhythm 12, n.º 5 (mayo de 2015): 943–49. http://dx.doi.org/10.1016/j.hrthm.2015.01.038.

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Taddeucci, Simone, Gianluca Mirizzi y Amato Santoro. "Lumenless and Stylet-Driven Leads for Left Bundle Branch Area Pacing: Materials, Techniques, Benefits, and Trade-Offs of the Two Approaches". Journal of Clinical Medicine 13, n.º 16 (13 de agosto de 2024): 4758. http://dx.doi.org/10.3390/jcm13164758.

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Left bundle branch area pacing (LBBPa) is an innovative technique for physiological pacing. Compared with His bundle pacing, LBBPa provides better pacing thresholds, lower rates of macrodislodgment, and a reliable strategy for cardiac resynchronization. LBBPa traditionally employs lumenless leads (LLL), which are characterized by small lead bodies and a fixed helix design. These features guarantee stability, avoid helix retraction, and facilitate easier septal penetration, all contributing to an advantageous learning curve. On the other hand, stylet-driven pacing leads (SDL) have shown comparable success rates related to lumenless pacing leads, although they carry risks of helix retraction and lead fracture. SDL have been increasingly employed with favorable results, as they provide good maneuverability and support during implantation with continuous monitoring of ECG-paced morphology. Different manufacturers are offering a variety of SDL, and new dedicated tools are being developed to simplify lead implantation. In this review, we examine the procedural techniques, advantages, and limitations of the most commonly used pacing leads and tools for LBBPa, and we summarize the complications associated with both lumenless leads (LLL) and stylet-driven leads (SDL).

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48

Gurgu, Andra, Dragos Cozma y Mihail G. Chelu. "Left bundle branch pacing: the new kid on the block". Romanian Journal of Cardiology 30, n.º 4 (4 de enero de 2021): 571–75. http://dx.doi.org/10.47803/rjc.2020.30.4.571.

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Right ventricular pacing is has deletorius effects due to left ventricular dysynchrony and remodelling and may result in heart failure. Over the last decade, His bundle pacing has emerged as the most physiologic form pacing. However, it has limitations, such as higher capture thresholds, lower R wave amplitudes, atrial oversensing, and increased risk for lead revisions from late threshold increase with subsequent premature battery depletion, which has prevented a wider adoption of this technique in routine clinical practice. Left bundle branch pacing has been developed as an alternative physiologic pacing strategy that overcomes most of His bundle pacing limitations. This article summarizes the current status of left bundle branch pacing. Keywords: His bundle pacing, left bundle branch pacing, cardiac resynchronization, therapy heart failure.

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PESTREA, Catalin, Alexandra GHERGHINA, Irina PINTILIE y Florin ORTAN. "Learning Curve for Left Bundle Branch Area Pacing – the Experience of a Romanian Academic Center". Romanian Journal of Cardiology 31, n.º 2 (2 de julio de 2021): 327–34. http://dx.doi.org/10.47803/rjc.2021.31.2.327.

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Introduction: There is an increasing interest in the past decade for more physiological pacing strategies due to detrimental long-term right ventricular pacing. His bundle pacing is the most physiological one, but it has some drawbacks, mainly an increased pacing threshold. Left bundle branch area pacing (LBBAP) emerged in the recent years as the next step in conduction system pacing. We present our initial experience and learning curve with this latter procedure. Material and methods: During January 2019 and February 2021, 20 patients with pacing indications that failed initial permanent His bundle pacing underwent successful LBBAP. Results: The mean age was 65.9 ± 12.7 years. The indications for cardiac pacing were AV block in 14 patients(70%) and cardiac resynchronization therapy in 6 patients (30%). At baseline, normal QRS complex was noted in 9 patients, a left bundle branch block pattern in 10 patients and a right bundle branch block in one patient. A total of 18 dual-chamber and one single chamber pacemakers were implanted and a cardiac resynchronization therapy defibrillator (CRT-D) device. The acute pacing threshold was 0.56±0.2 V at 0.4ms, the sensing threshold was 10.3±3.9 mV and the impedance was 684.9±112.2 Ω. The overall QRS duration decreased after LBBAP from 128.5 ± 27ms to 103.6 ± 17.4ms (p= 0.001). In patients with baseline wide QRS complex there was a highly significant decrease from 148.2 ± 11.6 ms to 104.7 ± 19.4 ms (p<0.001). The fl uoroscopy time, including the time spent for His bundle location, was 13.8 ± 8.5 minutes. The pacing thresholds remained constant after three-months (0.6 ± 0.2 V vs. 0.56 ± 0.2 V at 0.4 ms). We had two intraprocedural septal perforations without any consequences and three micro dislodgements at follow-up with pure left septal capture. Conclusion: Left bundle branch area pacing is a feasible physiological pacing technique with a high success rate and the potential to overcome the limits of permanent His bundle pacing. It can be successfully performed virtually in all types of pacing indications, including cardiac resynchronization therapy as provides a rapid and synchronous activation of the left ventricle.

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Petrovic, Milan, Bosiljka Vujisic-Tesic, Goran Milasinovic, Danijela Zamaklar-Trifunovic, Ivana Nedeljkovic, Vera Jelic, Marija Boricic, Zarko Calovic, Olga Petrovic y Marko Banovic. "New echocardiographic techniques in optimal patient selection for cardiac resynchronization therapy in the treatment of chronic heart failure". Srpski arhiv za celokupno lekarstvo 137, n.º 5-6 (2009): 304–9. http://dx.doi.org/10.2298/sarh0906304p.

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Cardiac resynchronization therapy (CRT) has important role in the contemporary treatment of heart failure, systolic dysfunction and mechanical disynchrony. Classical indications for CRT are severe heart failure (NYHA class III or IV), a broad QRS (more than 120 ms) and left ejection fraction less than 35% despite optimal medical therapy. Several have studies demonstrated the important role of echocardiography in patient selection for CRT, follow up and estimation of CRT effects, as well as the optimization of biventricular pacemaker. Basically, there are three types of cardiac asynchrony: interventricular asynchrony, between the right and left ventricle, intraventricular asynchrony, between the myocardial segments within the left ventricle and atrioventricular asynchrony, between the atria and ventricles. Although many echocardiographic techniques are used in patient selection for CRT, no ideal approach has yet been found. There are several techniques and parameters used in the assessment of myocardial asynchrony: two dimensional (2D) echocardiography, one dimensional echocardiography (M-mode), Doppler echocardiography, different modalities of tissue Doppler including Colour Coded Tissue Doppler Imaging - TDI, measurements of local tissue deformation indices (strain and strain rate), speckle tracking, 3D echocardiography, semiquantitative assessment of myocardial border, vector velocity imaging. Each of these techniques has advantages and limitations. A special accent in this revue is on the consensus report from the American Society of Echocardiography Dyssynchrony Writing group. According to this consensus report color coded tissue Doppler is the most appropriate technique for myocardial asynchrony estimation and patients selection for CRT. The same group recommended that definitive decision for CFT implantation should not be based only on echocardiographic analysis, but rather on the whole clinical aspect of the patient.

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