Why the study?
One-third of patients receiving CRT are non-responders, and when implanting CSP with an ICD or CRT-D, the optimal port connection for HBP and LBBAP leads remains an issue.
Utilizing atrial ports for His-bundle and left bundle branch area pacing leads provides a feasible technical solution for upgrading to conduction system pacing in patients with chronic atrial fibrillation and severe heart failure.
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May offer a feasible CSP-CRT upgrade option in AF-HF; hypothesis-generating and requires prospective validation before practice change.
Cardiac resynchronization therapy (CRT) is a standard treatment for patients with severe congestive heart failure. However, one-third of patients receiving CRT are non-responders. Conduction system pacing (CSP), including His-bundle pacing (HBP) and left bundle branch area pacing (LBBAP), has become an alternative to CRT therapy. Furthermore, CRT therapy with CSP has shown to be more effective than CRT alone. When an implantable cardiac defibrillator or CRT-defibrillator is implanted with CSP, the problem of which port the HBP lead and LBBAP lead should be connected to arises. We report 2 cases of upgrading to CRT with CSP by utilizing the atrial ports for HBP and LBBAP leads. The procedure is a simple, reasonable, and effective therapy for end-stage heart failure.
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Nohno et al. (2023) studied this question.
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