Targeted left ventricular lead placement, multi-site pacing, and endocardial pacing represent promising alternative strategies to improve cardiac resynchronization therapy response rates.
Do targeted lead placement, multi-site pacing, or endocardial pacing improve response to CRT in patients with heart failure and ventricular dyssynchrony?
Novel CRT delivery methods, including targeted lead placement and endocardial pacing, may improve outcomes for the significant minority of heart failure patients who do not respond to conventional CRT.
Cardiac resynchronization therapy (CRT) is a proven treatment adjunct for selected patients with heart failure and evidence of ventricular dyssynchrony. When applying most contemporary guidelines the accepted response rate has remained static with up to one-third of patients failing to respond. Empiric lateral/posterolateral lead positioning may not be the optimal strategy in all patients, particularly in those with extensive scar and there have been developments that suggest an approach whereby the latest mechanically activating segment is targeted for left ventricular (LV) lead placement may be of some benefit. Additionally, alternative means of delivering CRT, either by means of multi-site pacing or LV endocardial pacing, have similarly shown promise. At a time where novel predictors of response to CRT have proved disappointing in multi-center trials, a paradigm shift away from prediction towards better delivery of CRT may potentially be of most benefit to the significant minority who do not respond.
Sohal et al. (2014) conducted a review in Heart failure with ventricular dyssynchrony. Targeted lead placement, multi-site pacing, and LV endocardial pacing was evaluated. Targeted left ventricular lead placement, multi-site pacing, and endocardial pacing represent promising alternative strategies to improve cardiac resynchronization therapy response rates.