Targeted Left Ventricular Lead Implantation Strategy for Non-Left Bundle Branch Block Patients

Singh, Jagmeet P.; Berger, Ronald D.; Doshi, Rahul N.; Lloyd, Michael S.; Moore, Douglas; Stone, James; Daoud, Emile G.

doi:10.1016/j.jacep.2020.04.034

Cited by 35 publications

(29 citation statements)

References 23 publications

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“…However, the role of imaging is more pronounced and effective in those with atypical LBBB and narrower QRS duration (120 to 150 ms). This is confirmed further with the recently published ENHANCE CRT (CRT Implant Strategy Using the Longest Electrical Delay for Non‐Left Bundle Branch Block Patients) trial which showed that without an imaging guidance, patients with non‐LBBB had no significant clinical improvement, even with the use of QLV‐based approach 20 . A further confirmation of this can be found in the secondary analysis of the STARTER trial which showed that an optimal lead position was only associated with improved clinical outcomes among non‐LBBB group 10 …”

Section: Discussionsupporting

confidence: 71%

Imaging‐guided cardiac resynchronization therapy: A meta‐analysis of randomized controlled trials

Kheiri

Przybylowicz

Simpson

et al. 2021

Pacing Clinical Electrophis

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Background Among patients with heart failure and left ventricular (LV) dysfunction despite guideline directed medical therapy, cardiac resynchronization (CRT) is an effective technology to reverse LV remodeling. Given that a large portion of patients are non‐responders, alternatives to traditional LV‐lead placement have been explored. A promising alternative is image targeted placement of an LV‐lead to latest mechanically activated segment without scar. Methods Electronic database search for randomized controlled trials (RCTs) that evaluated the imaging‐guided LV‐lead placement on clinical, echocardiographic, and functional outcomes. The primary outcome was a composite of mortality and heart failure hospitalization. The secondary outcomes included CRT responders, New York Heart Association (NYHA), 6‐minute walk test, Minnesota Living with Heart Failure Questionnaire (MLHFQ), and ejection fraction (EF) changes. Results Analysis included 4 RCTs of 691 patients with an average follow‐up of 2 years (age 69.5 ± 10.3 years, 76% males, 54% ischemic cardiomyopathy, 81% with NYHA classes III/IV, and EF of 24.4% ± 8). The most common site for LV‐lead paced segment was the anterolateral segment (45%) and at mid‐LV (49%). Compared with the control, imaging‐guided LV‐lead placement was associated with a significant reduction of the primary outcome (hazard ratio [HR] = 0.60; 95% CI = 0.40–0.88; p = .01), higher CRT responders (odd ratio [OR] = 2.10; p < .01), more NYHA improvements by ≥1 (OR = 1.89; p = .01), increased 6MWT (mean difference [MD] = 25.78 feet; p < .01), and lower MLHFQ (MD = ‐4.04; p = .04), without significant differences in the LVEF (p = .08). Conclusions In patients undergoing CRT, imaging‐guided LV‐lead placement was associated with improved clinical, echocardiographic, and functional status.

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Section: Discussionsupporting

confidence: 71%

Imaging‐guided cardiac resynchronization therapy: A meta‐analysis of randomized controlled trials

Kheiri

Przybylowicz

Simpson

et al. 2021

Pacing Clinical Electrophis

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“…5,38 Moreover, when compared to an anatomic approach, QLV-guided implantation may only be beneficial in patients with typical LBBB morphology. 39 Because of small differences in intrinsic activation delay when LVLP already is optimal, electrical indices such as LV-paced to RV-sensed wavefront propagation (ie, LVp-RVs) correlate poorly to QLV as well. 32 Therefore, LV-paced activation effects are highly unpredictable when based on stimulation site alone, despite widely variable acute electrical responses.…”

Section: Electrically Guidedmentioning

confidence: 99%

“…Table 1 Prospective image-guided studies with a control group investigating targeted lead placement Bai et al 51 Khan et al 44 Saba et al 45 Sommer et al 48 Bertini et al 46 Stephansen et al 49 No morphology, however, image-guided LVLP resulted in superior outcome compared to contemporary placement, whereas a QLV-guided approach failed to do so. 39,50 Although previously mentioned limitations of an electrically guided approach should be considered, image-guided approaches may have insufficiently utilized potential as well.…”

Section: Image-guidedmentioning

confidence: 99%

Optimizing lead placement for pacing in dyssynchronous heart failure: The patient in the lead

et al. 2021

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Cardiac resynchronization therapy (CRT) greatly reduces morbidity and mortality in patients with dyssynchronous heart failure. However, despite tremendous efforts, response has been variable and can be further improved. Although optimizing left ventricular lead placement (LVLP) is arguably the cornerstone of CRT, the procedure of LVLP using the transvenous approach has remained largely unchanged for more than 2 decades. Improvements have been developed using scar location and electrical and/or mechanical mapping. Interest in conduction system pacing as an alternative to biventricular pacing has emerged recently. Conduction system pacing is promising but may not be suitable for all patients with dyssynchronous heart failure. This review underscores the importance of a patient-tailored approach and discusses the potential applications of both conduction system pacing and targeted biventricular CRT.

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“…Hisian pacing has been recently described as a viable alternative to biventricular pacing in patients with indication for cardiac resynchronization 12 .…”

Section: Discussionmentioning

confidence: 99%

Management of heart failure with His bundle pacing in right bundle branch block: Case report

Gómez-Flores¹,

Pérez-Báez²,

Muñoz³

et al. 2021

ACME

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Cardiac resynchronization therapy has proven to be an effective therapy in patients with left bundle branch block and heart failure. Male, 47 years old, heart failure with a left ventricle ejection fraction of 17%, idiopathic heart failure. ECG with sinus rhythm, 1 st degree AV block, PR 400 ms, complete right bundle branch block, anterior hemi-fascicle of the left bundle of His, and QRS duration 200 ms. We decided to perform a selective His bundle pacing. In patients with right bundle branch block the biventricular cardiac resynchronization is not indicated due to low treatment response. His bundle pacing allows recruiting the blocked branch and restoring conduction throughout it; therefore, in the absence of necrosis the biventricular synchrony is achieved. We presented a case of his bundle pacing with recruitment of the right bundle branch, which reestablish biventricular synchrony measured by speckle tracking, and with a significant increase of the left ventricle ejection fraction from 17 to 36.6%, with an absolute increase of 19.6%.

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Targeted Left Ventricular Lead Implantation Strategy for Non-Left Bundle Branch Block Patients

Cited by 35 publications

References 23 publications

Imaging‐guided cardiac resynchronization therapy: A meta‐analysis of randomized controlled trials

Imaging‐guided cardiac resynchronization therapy: A meta‐analysis of randomized controlled trials

Optimizing lead placement for pacing in dyssynchronous heart failure: The patient in the lead

Management of heart failure with His bundle pacing in right bundle branch block: Case report

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