Cardiac Resynchronization Therapy Delivered Using Left Bundle Branch Pacing: Are We Now Ready for Randomized Control Trials?

摘要

Cardiac resynchronization therapy (CRT) is established as an important treatment for patients with left ventricular impairment and conduction system disease. The aim of treatment is to improve cardiac function by delivering more physiological cardiac activation. Biventricular pacing is the most well-established method for delivering CRT (BiV-CRT). It has been shown in multiple high-quality randomized controlled trials (RCTs) to improve outcomes in patients with systolic heart failure and QRS prolongation (1). Despite the success of BiV-CRT, there are reasons to develop alternatives. First, left ventricular lead implantation is not always possible; ideally alternatives could be performed at the time of the original implantation attempt. Second, there is potential to deliver more effective ventricular resynchronization. When BiV-CRT is delivered to patients with left bundle branch block (LBBB), it produces only modest reductions in QRS duration and does not restore normal physiological ventricular activation (2).