Endocardial pacing offers a promising alternative for the 30-50% of heart failure patients who fail to respond to traditional transvenous epicardial cardiac resynchronisation therapy.
This review highlights that 30-50% of patients fail to respond to traditional epicardial CRT due to multifactorial causes, and suggests biventricular endocardial pacing as a promising alternative to overcome these limitations.
Heart failure is a complex clinical syndrome associated with a significant morbidity and mortality burden. Reductions in left ventricular (LV) function trigger adaptive mechanisms, leading to structural changes within the LV and the potential development of dyssynchronous ventricular activation. This is the substrate targeted during cardiac resynchronisation therapy (CRT); however, around 30-50% of patients do not experience benefit from this treatment. Non-response occurs as a result of pre-implant, peri-implant and post implant factors but the technical constraints of traditional, transvenous epicardial CRT mean they can be challenging to overcome. In an effort to improve response, novel alternative methods of CRT delivery have been developed and of these endocardial pacing, where the LV is stimulated from inside the LV cavity, appears the most promising.
Sieniewicz et al. (Fri,) conducted a review in Heart failure with non-response to cardiac resynchronisation therapy. Endocardial pacing vs. Traditional transvenous epicardial CRT was evaluated. Endocardial pacing offers a promising alternative for the 30-50% of heart failure patients who fail to respond to traditional transvenous epicardial cardiac resynchronisation therapy.
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