Endocardial left ventricular pacing

Abstract

Cardiac resynchronization therapy (CRT) is an effective treatment for dyssynchronous heart failure; however, 30–50% of patients fail to improve after implant. Endocardial left ventricular (LV) pacing is an alternative therapy for patients who do not respond to conventional CRT or in whom placement of a lead via the coronary sinus is not possible. It enables pacing at a wide variety of sites, without restrictions due to coronary sinus anatomy, and there is evidence of superior electrical resynchronization and hemodynamic response compared with conventional epicardial CRT. In this article, we discuss the potential advantages and disadvantages of endocardial LV pacing compared with conventional CRT, review the evidence for the delivery of endocardial LV pacing using both lead-based and leadless systems, and explore possible future directions of this novel technology.

Synchronizing Beats: From Theory to Advances and Insight in Cardiac Resynchronization Therapy

“…The SELECT-LV trial of 35 patients showed a high 97.1% procedural success and 84.8% clinical response at 6 months [107]. An international WiSE-CRT registry of 90 patients demonstrated good procedural success at 94.4% and 69.8% clinical response at 6 months Figures 23 and 24 [98,104,108]. Endocardial LV pacing warrants further research into leadless delivery systems as a promising option for CRT non-responders.…”

“…Endocardial pacing seems to produce more efficient resynchronization than epicardial pacing. It allows pacing from a variety of LV sites without restrictions from coronary sinus anatomy [104]. Potential advantages of endocardial LV pacing include optimizing the pacing site to target the latest activation area based on evidence from trials like TARGET, which showed echo-guided targeting had superior response compared to empirical placement [1].…”

“…Despite technological advancements and improved surgical techniques, complications such as LV lead failure, hematomas, dissections, perforations, heart block, lead Endocardial LV pacing-components of the WiSE-CRT system [104].…”

Real-time three-dimensional transthoracic echocardiography in quantification of left ventricular dyssynchrony

“…Итоговое расположение левожелудочкового электрода, прежде всего, зависит от анатомии вен коронарного синуса, наличия или отсутствия у пациента диафрагмальной стимуляции, а также свойств и стабильности положения самого электрода [34,35]. В 8-10% случаев, по различным данным, наблюдается невозможность имплантации ЛЖ электрода трансвенозным способом [34,35].…”

“…Итоговое расположение левожелудочкового электрода, прежде всего, зависит от анатомии вен коронарного синуса, наличия или отсутствия у пациента диафрагмальной стимуляции, а также свойств и стабильности положения самого электрода [34,35]. В 8-10% случаев, по различным данным, наблюдается невозможность имплантации ЛЖ электрода трансвенозным способом [34,35]. Одним из активно изучаемых вариантов изолированной левожелудочковой (ЛЖ) стимуляции является методика эндокардиальной стимуляции с помощью различных типов эндокардиальных электродов [36] и безэлектродных систем [38,39].…”