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His-Bundle Pacing and LV Endocardial Pacing as Alternatives to Traditional Cardiac Resynchronization Therapy

  • Invasive Electrophysiology and Pacing (EK Heist, Section Editor)
  • Published:
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Abstract

Purpose of Review

Cardiac resynchronization therapy (CRT) using biventricular pacing (BVP) is the cornerstone of treatment for patients with heart failure and left bundle branch block. Up to a third of patients do not respond to BVP. This article reviews the utility of His-bundle pacing (HBP) and Left ventricular (LV) endocardial pacing as alternatives to BVP to provide ventricular synchrony.

Recent Findings

HBP has shown promising results in observational studies. By significantly narrowing or normalizing QRS, HBP has improved clinical outcomes including ejection fractions both as a rescue option in patients who failed BVP or as a primary alternative. LV endocardial pacing has also shown promise with improved clinical outcomes. Using traditional pacing leads or novel technology, direct stimulation of the LV endocardium allows for better site selection as well as a more physiological activation of the LV compared to traditional epicardial LV stimulation.

Summary

HBP and LV endocardial pacing are valuable alternatives to traditional BVP to achieve CRT. Randomized clinical trials in progress will allow for a deeper understanding of how they can benefit our patients.

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Authors and Affiliations

  1. Division of Cardiac Electrophysiology, Geisinger Heart Institute, MC 36-10, 1000 E Mountain Blvd, Wilkes-Barre, PA, 18711, USA

    Pugazhendhi Vijayaraman & Faiz A. Subzposh

Authors
  1. Pugazhendhi Vijayaraman
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  2. Faiz A. Subzposh
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Correspondence to Pugazhendhi Vijayaraman.

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Conflict of Interest

Pugazhendhi Vijayaraman reports grants, personal fees, and non-financial support from Medtronic; personal fees and non-financial support from Boston Scientific; personal fees from Abbott; and personal fees from Biotronik. In addition, Dr. Vijayaraman has a patent His-bundle pacing delivery catheter pending.

Faiz Subzposh reports grants, personal fees, and non-financial support from Medtronic.

Human and Animal Rights and Informed Consent

This article contains studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Invasive Electrophysiology and Pacing

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Vijayaraman, P., Subzposh, F.A. His-Bundle Pacing and LV Endocardial Pacing as Alternatives to Traditional Cardiac Resynchronization Therapy. Curr Cardiol Rep 20, 109 (2018). https://doi.org/10.1007/s11886-018-1046-z

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  • DOI: https://doi.org/10.1007/s11886-018-1046-z

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