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Current Cardiology Reports

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01-11-2018 | Invasive Electrophysiology and Pacing (EK Heist, Section Editor)

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

Authors: Pugazhendhi Vijayaraman, Faiz A. Subzposh

Published in: Current Cardiology Reports | Issue 11/2018

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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Title: His-Bundle Pacing and LV Endocardial Pacing as Alternatives to Traditional Cardiac Resynchronization Therapy
Authors: Pugazhendhi Vijayaraman
Faiz A. Subzposh
Publication date: 01-11-2018
Publisher: Springer US
Published in: Current Cardiology Reports / Issue 11/2018
Print ISSN: 1523-3782
Electronic ISSN: 1534-3170
DOI: https://doi.org/10.1007/s11886-018-1046-z

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