Comparison of methods for delivering cardiac resynchronization therapy: electrical treatment targets and mechanisms of action.

IF 2.9 3区 医学 Q3 ENGINEERING, BIOMEDICAL
Florentina Simader, Ahran Arnold, Zachary Whinnett
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引用次数: 2

Abstract

Introduction: Cardiac resynchronization therapy (CRT) has been developed as a treatment for patients with conduction system dysfunction and impairment of ventricular performance. The aim is to restore more physiological cardiac activation and thereby improve cardiac function, symptoms, and outcomes.

Areas covered: In this review, we discuss potential electrical treatment targets for patients with heart failure and how these electrical treatment targets may determine the optimal pacing approach for delivering CRT.

Expert opinion: The most well-established method for delivering CRT is biventricular pacing (BVP). BVP improves symptoms and reduces mortality in patients with left bundle branch block (LBBB). However, patients continue to suffer from heart failure symptoms and decompensations despite receiving BVP. There may be scope to deliver more effective CRT since BVP does not restore physiological ventricular activation. Furthermore, the results with BVP in patients with non-LBBB conduction system disease have been generally disappointing. Alternative pacing approaches to BVP are now available, including conduction system pacing and left ventricular endocardial pacing. These newer pacing approaches offer exciting potential to not only offer an alternative to coronary sinus lead implantation in the case of implant failure but to potentially deliver more effective treatment in LBBB and maybe even extend the indications for CRT beyond LBBB.

心脏再同步化治疗方法的比较:电治疗靶点和作用机制。
心脏再同步化治疗(CRT)已经发展成为一种治疗传导系统功能障碍和心室功能障碍的患者。目的是恢复更多的生理性心脏激活,从而改善心脏功能、症状和预后。涉及领域:在这篇综述中,我们讨论了心力衰竭患者的潜在电治疗靶点,以及这些电治疗靶点如何决定CRT的最佳起搏方法。专家意见:最完善的CRT方法是双心室起搏(BVP)。BVP可改善左束支阻滞(LBBB)患者的症状并降低死亡率。然而,尽管接受BVP治疗,患者仍会出现心力衰竭症状和失代偿。由于BVP不能恢复生理性心室激活,因此可能存在提供更有效CRT的空间。此外,非lbbb传导系统疾病患者使用BVP的结果通常令人失望。BVP的其他起搏方法现在可用,包括传导系统起搏和左心室心内膜起搏。这些新的起搏方法提供了令人兴奋的潜力,不仅在植入失败的情况下提供了冠状动脉窦导联植入的替代方案,而且可能在LBBB中提供更有效的治疗,甚至可能将CRT的适应症扩展到LBBB之外。
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来源期刊
Expert Review of Medical Devices
Expert Review of Medical Devices 医学-工程:生物医学
CiteScore
5.90
自引率
3.20%
发文量
69
审稿时长
6-12 weeks
期刊介绍: The journal serves the device research community by providing a comprehensive body of high-quality information from leading experts, all subject to rigorous peer review. The Expert Review format is specially structured to optimize the value of the information to reader. Comprehensive coverage by each author in a key area of research or clinical practice is augmented by the following sections: Expert commentary - a personal view on the most effective or promising strategies Five-year view - a clear perspective of future prospects within a realistic timescale Key issues - an executive summary cutting to the author''s most critical points In addition to the Review program, each issue also features Medical Device Profiles - objective assessments of specific devices in development or clinical use to help inform clinical practice. There are also Perspectives - overviews highlighting areas of current debate and controversy, together with reports from the conference scene and invited Editorials.
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