The role of conduction system pacing in patients with atrial fibrillation

Wijesuriya, Nadeev; Mehta, Vishal; Vere, Felicity de; Strocchi, Marina; Behar, Jonathan M.; Niederer, Steven; Rinaldi, Christopher A.

doi:10.3389/fcvm.2023.1187754

Cited by 3 publications

(1 citation statement)

References 58 publications

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“…As highlighted throughout, the management of arrhythmia and heart failure is ever evolving, with novel treatments in both fields emerging in recent years. Although beyond the full scope of this article, with more detailed reviews available elsewhere ( 108 ), it is impossible to ignore the emergence of conduction system pacing (CSP) as a feasible, theoretically more physiological alternative to traditional BVP. Specifically, the adoption of left bundle branch pacing (LBBP) has provided a solution to the relatively low procedural success rates which hampered its predecessor, His-bundle pacing (HBP) ( 109 ).…”

Section: Novel Directionsmentioning

confidence: 99%

Managing arrhythmia in cardiac resynchronisation therapy

de Vere,

Wijesuriya,

Elliott

et al. 2023

Front. Cardiovasc. Med.

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Arrhythmia is an extremely common finding in patients receiving cardiac resynchronisation therapy (CRT). Despite this, in the majority of randomised trials testing CRT efficacy, patients with a recent history of arrhythmia were excluded. Most of our knowledge into the management of arrhythmia in CRT is therefore based on arrhythmia trials in the heart failure (HF) population, rather than from trials dedicated to the CRT population. However, unique to CRT patients is the aim to reach as close to 100% biventricular pacing (BVP) as possible, with HF outcomes greatly influenced by relatively small changes in pacing percentage. Thus, in comparison to the average HF patient, there is an even greater incentive for controlling arrhythmia, to achieve minimal interference with the effective delivery of BVP. In this review, we examine both atrial and ventricular arrhythmias, addressing their impact on CRT, and discuss the available evidence regarding optimal arrhythmia management in this patient group. We review pharmacological and procedural-based approaches, and lastly explore novel ways of harnessing device data to guide treatment of arrhythmia in CRT.

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Section: Novel Directionsmentioning

confidence: 99%

Managing arrhythmia in cardiac resynchronisation therapy

de Vere,

Wijesuriya,

Elliott

et al. 2023

Front. Cardiovasc. Med.

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Personalized computational electro-mechanics simulations to optimize cardiac resynchronization therapy

Capuano,

Regazzoni,

Maines

et al. 2024

Biomech Model Mechanobiol

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In this study, we present a computational framework designed to evaluate virtual scenarios of cardiac resynchronization therapy (CRT) and compare their effectiveness based on relevant clinical biomarkers. Our approach involves electro-mechanical numerical simulations personalized, for patients with left bundle branch block, by means of a calibration obtained using data from Electro-Anatomical Mapping System (EAMS) measures acquired by cardiologists during the CRT procedure, as well as ventricular pressures and volumes, both obtained pre-implantation. We validate the calibration by using EAMS data coming from right pacing conditions. Three patients with fibrosis and three without are considered to explore various conditions. Our virtual scenarios consist of personalized numerical experiments, incorporating different positions of the left electrode along reconstructed epicardial veins; different locations of the right electrode; different ventriculo-ventricular delays. The aim is to offer a comprehensive tool capable of optimizing CRT efficiency for individual patients. We provide preliminary answers on optimal electrode placement and delay, by computing some relevant biomarkers such as $$dP/dt_{max}$$ d P / d t max , ejection fraction, stroke work. From our numerical experiments, we found that the latest activated segment during sinus rhythm is an effective choice for the non-fibrotic cases for the location of the left electrode. Also, our results showed that the activation of the right electrode before the left one seems to improve the CRT performance for the non-fibrotic cases. Last, we found that the CRT performance seems to improve by positioning the right electrode halfway between the base and the apex. This work is on the line of computational works for the study of CRT and introduces new features in the field, such as the presence of the epicardial veins and the movement of the right electrode. All these studies from the different research groups can in future synergistically flow together in the development of a tool which clinicians could use during the procedure to have quantitative information about the patient’s propagation in different scenarios.

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Concepts of Cardiac Dyssynchrony and Dynamic Approach

Catrina,

Batar,

Manitiu

et al. 2024

Diagnostics

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Cardiac conduction involves electrical activity from one myocyte to another, creating coordinated contractions in each. Disruptions in the conducting system, such as left bundle branch block (LBBB), can result in premature activation of specific regions of the heart, leading to heart failure and increased morbidity and mortality. Structural alterations in T-tubules and the sarcoplasmic reticulum can lead to dyssynchrony, a condition that can be treated by cardiac resynchronization therapy (CRT), which stands as a cornerstone in this pathology. The heterogeneity in patient responses underscored the necessity of improving the diagnostic approach. Vectocardiography, ultra-high-frequency ECG, 3D echocardiography, and electrocardiographic imaging seem to offer advanced precision in identifying optimal candidates for CRT in addition to the classic diagnostic methods. The advent of His bundle pacing and left bundle branch pacing further refined the approach in the treatment of dyssynchrony, offering more physiological pacing modalities that promise enhanced outcomes by maintaining or restoring the natural sequence of ventricular activation. HOT-CRT emerges as a pivotal innovation combining the benefits of CRT with the precision of His bundle or left bundle branch area pacing to optimize cardiac function in a subset of patients where traditional CRT might fall short.

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The role of conduction system pacing in patients with atrial fibrillation

Cited by 3 publications

References 58 publications

Managing arrhythmia in cardiac resynchronisation therapy

Managing arrhythmia in cardiac resynchronisation therapy

Personalized computational electro-mechanics simulations to optimize cardiac resynchronization therapy

Concepts of Cardiac Dyssynchrony and Dynamic Approach

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