Left ventricular endocardial leadless pacing brings new hope to patients with heart failure

摘要

Cardiac resynchronization therapy (CRT) provides prognostic and symptomatic benefits for patients with heart failure and left ventricular (LV) dyssynchrony. It requires the implantation of an LV lead, usually placed in a tributary of the coronary sinus. Despite important progress made in the development of dedicated instrumentation, challenges still remain, and the procedure may even be unsuccessful for various reasons, including CS occlusion, dissection, abnormal ostium of the CS, coronary vein stenosis, lead instability, high threshold, or phrenic nerve stimulation. Even if the procedure is successful, about 30% of patients receiving CRT do not respond to treatment [1 ]. Although the underlying reasons for the lack of CRT response in some patients are undoubtedly multifactorial, some problems have been identified and may have the potential to be ameliorated. Firstly, limitations imposed by coronary venous anatomy on the selection of the site for LV stimulation are thought to be a major contributor to the lack of CRT response. Secondly, stimulation is epicardial, which leads to delayed electrical activation of the LV in comparison to endocardial stimulation, and has been shown to provide less hemodynamic benefit [2].