Key result
Right ventricular pacing combined with left ventricular pacing produced confluent left ventricular depolarization and reverse remodeling in a patient with heart failure and left bundle branch block.
Why the study?
The effects of right ventricle pacing on left ventricle activation in heart failure patients with left bundle branch block are less studied.
Does individualized RV pacing timing improve electrical resynchronization in a heart failure patient with LBBB?
Case Report (n=1)
Does individualized RV pacing timing improve electrical resynchronization in a heart failure patient with LBBB?
Individualized pacing prescriptions, including specific RV pacing timing, may be necessary for optimal electrical resynchronization and reverse remodeling in CRT.
RV pacing effects on LV activation in CRT remain understudied; leaves open optimal fusion strategies in LBBB.
BACKGROUND: Cardiac resynchronization therapy (CRT) aims to correct delayed left ventricle (LV) activation resulting from left bundle branch block (LBBB). The source of LV activation delay resides in the septum and/or anterior LV. LV pacing, timed with intrinsic right bundle branch (RBB) conduction, may restore "physiological" biventricular activation. This is not assured because LV paced wavefronts themselves propagate unpredictably. Less studied are effects of right ventricle (RV) pacing on LV activation in heart failure (HF) patients with LBBB. METHODS AND RESULTS: In this case RV pacing pre-excited precisely the region left behind during LV pacing. Consequently, biventricular pacing produced confluent LV depolarization (the patient "responded" to this with reverse remodeling). CONCLUSION: Successful electrical resynchronization requires best combination and timing of paced/intrinsic wavefront(s). This demands individualization. Sometimes, an RV paced wavefront may be valuable to resynchronization.
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Varma et al. (2019) conducted a case report in Heart failure with left bundle branch block (n=1). Right ventricular pacing was evaluated on Left ventricular depolarization and reverse remodeling. Right ventricular pacing combined with left ventricular pacing produced confluent left ventricular depolarization and reverse remodeling in a patient with heart failure and left bundle branch block.
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