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Biventricular Pacing for Patients with Complete Heart Block

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Clinical Controversies in Device Therapy for Cardiac Arrhythmias

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Abstract

Complete heart block (CHB) is defined by the failure of atrial impulses to propagate through the conduction system to the ventricles. Pacemakers are indicated therapies for the treatment of nonreversible CHB, and traditionally this has been achieved with right ventricular (RV) transvenous devices. During the past two decades, biventricular pacing with a left ventricular (LV) pacing lead, or cardiac resynchronization therapy (CRT), has emerged as an alternative therapy with proven benefit in patients with heart failure due to systolic dysfunction and preexisting intraventricular conduction delay. Data are most clear to support a clinical benefit of CRT over traditional RV pacing (RVP) in patients with CHB and LVEF ≤35%, along with favorable data in patients with CHB and intermediate LVEF 36–49%. In patients with CHB and preserved LVEF ≥50%, there is less evidence to support the practice of de novo CRT over RVP. Other populations of interest include patients with congenital heart block and post-AV node ablation. In this comprehensive review, we provide a summary of the evidence for CRT versus traditional RVP in each of these subgroups and offer a suggested clinical approach to evaluating a patient with CHB for CRT.

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Author information

Authors and Affiliations

  1. Department of Internal Medicine, University of Chicago Medicine, The Pritzker School of Medicine at the University of Chicago, Chicago, IL, USA

    Hannah E. Wey

  2. Center for Arrhythmia Care, Heart and Vascular Institute, University of Chicago Medicine, The Pritzker School of Medicine at the University of Chicago, Chicago, IL, USA

    Gaurav A. Upadhyay & Roderick Tung

Authors
  1. Hannah E. Wey
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  2. Gaurav A. Upadhyay
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  3. Roderick Tung
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Corresponding author

Correspondence to Roderick Tung .

Editor information

Editors and Affiliations

  1. University of Rochester School of Medicine & Dentistry/Hackensack Meridian, School of Medicine at Seton Hall, University/Summit Medical Group, Short Hills, NJ, USA

    Jonathan S. Steinberg

  2. Electrophysiology Section, Cardiovascular Division, Univeristy of Pennsylvania, and the Cardiology Division, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA

    Andrew E. Epstein

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Wey, H.E., Upadhyay, G.A., Tung, R. (2019). Biventricular Pacing for Patients with Complete Heart Block. In: Steinberg, J., Epstein, A. (eds) Clinical Controversies in Device Therapy for Cardiac Arrhythmias . Springer, Cham. https://doi.org/10.1007/978-3-030-22882-8_5

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  • DOI: https://doi.org/10.1007/978-3-030-22882-8_5

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-22881-1

  • Online ISBN: 978-3-030-22882-8

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