scholarly journals Potential for leadless left bundle branch pacing for cardiac resynchronization: a case report

2021 ◽  
Author(s):  
Mark Elliott ◽  
Baldeep Sidhu ◽  
Lucy Jarrett-Smith ◽  
Vishal Mehta ◽  
Justin Gould ◽  
...  
Keyword(s):  
Case Report ◽  
Lateral Wall ◽  
Left Ventricular ◽  
Conduction System ◽  
Cardiac Resynchronization ◽  
Ventricular Remodelling ◽  
Resynchronization Therapy ◽  
Left Ventricular Remodelling ◽  
Bundle Branch Block ◽  
Endocardial Pacing

Introduction: Left bundle branch pacing is a recently described form of conduction system pacing which can correct left-bundle branch block and deliver cardiac resynchronization therapy (CRT). The WiSE-CRT system delivers leadless endocardial pacing and can improve symptoms and left ventricular remodelling in CRT non-responders. Case Report: We describe the case of a 57 year old male who underwent implantation of the WiSE-CRT system after failed conventional CRT. Pacing the left bundle during implant achieved superior electrical resynchronization and equivalent hemodynamic response compared to pacing the lateral wall. Conclusion: This case demonstrates the potential for leadless left bundle branch pacing.

Left ventricular endocardial or triventricular pacing to optimize cardiac resynchronization therapy in a chronic canine model of ischemic heart failure

2012 ◽  
Vol 303 (2) ◽  
pp. H207-H215 ◽  
Author(s):  
Pierre Bordachar ◽  
Nathan Grenz ◽  
Pierre Jais ◽  
Philippe Ritter ◽  
Christophe Leclercq ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiac Resynchronization Therapy ◽  
Canine Model ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy ◽  
Bundle Branch Block ◽  
Endocardial Lead ◽  
Endocardial Pacing ◽  
Optimal Site

Cardiac resynchronization therapy (CRT) is a proven treatment for heart failure but ∼30% of patients appear to not benefit from the therapy. Left ventricular (LV) endocardial and multisite epicardial [triventricular (TriV)] pacing have been proposed as alternatives to traditional LV transvenous epicardial pacing, but no study has directly compared the hemodynamic effects of these approaches. Left bundle branch block ablation and repeated microembolizations were performed in dogs to induce electrical dysynchrony and to reduce LV ejection fraction to <35%. LVdP/d tmax and other hemodynamic indexes were measured with a conductance catheter during LV epicardial, LV endocardial, biventricular (BiV) epicardial, BiV endocardial, and TriV pacing performed at three atrioventricular delays. LV endocardial pacing was obtained with a clinically available pacing system. The optimal site was defined as the site that increased dP/d tmax by the largest percentage. Implantation of the endocardial lead was feasible in all canines ( n = 8) without increased mitral regurgitation seen with transesophageal echocardiography and with full access to the different LV endocardial pacing sites. BiV endocardial pacing increased dP/d tmax more than BiV epicardial and TriV pacing on average ( P < 0.01) and at the optimal site ( P < 0.01). There were no significant differences between BiV epicardial and TriV pacing. BiV endocardial pacing was superior to BiV epicardial and to TriV pacing in terms of acute hemodynamic response. Further investigation is needed to confirm the chronic benefit of this approach in humans.

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