Key result
CSP preserves electrical and mechanical synchrony as a physiological alternative to RVP and BiV.
Effective management of acute decompensated heart failure requires aggressive decongestion, utilizing urinary sodium monitoring to guide diuretic dosing, and optimizing guideline-directed medical therapy prior to discharge.
Cautious adoption of conduction system pacing may be considered in select cases; leaves open need for randomized confirmation.
Heart failure (HF) is the common final pathway of several conditions and is characterized by hyperactivation of numerous neurohumoral pathways. Cardiorenal interaction plays an essential role in the progression of the disease, and the use of diuretics is a cornerstone in the treatment of hypervolemic patients, especially in acute decompensated HF (ADHF). The management of congestion is complex and, to avoid misinterpretations and errors, one must understand the interface between the heart and the kidneys in ADHF. Congestion itself may impair renal function and must be treated aggressively. Transitory elevations in serum creatinine during decongestion is not associated with worse outcomes and diuretics should be maintained in patients with clear hypervolemia. Monitoring urinary sodium after diuretic administration seems to improve the response to diuretics as it allows for adjustments in doses and a personalized approach. Adequate assessment of volemia and the introduction and titration of guideline-directed medical therapy are mandatory before discharge. An early visit after discharge is highly recommended, to assess for residual congestion and thus avoid readmissions.
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Kaddour et al. (2023) conducted a review in Bradycardia and heart failure requiring ventricular pacing. Conduction system pacing (His bundle pacing and left bundle branch area pacing) vs. Right ventricular pacing and biventricular pacing was evaluated. Conduction system pacing provides a physiological alternative to traditional right ventricular and biventricular pacing, preserving electrical and mechanical synchrony with growing clinical adoption.
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