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Biventricular or Conduction System Pacing for Cardiac Resynchronization Therapy: A Strategy for Cardiac Resynchronization Based on a Hybrid Approach

Background: Cardiac resynchronization therapy (CRT) is usually performed with biventricular pacing (BiVP), but recently, conduction system pacing (CSP) has been proposed as an alternative in case of BiVP failure. The aim of this study is to define an algorithm to choose between BiVP and CSP resynchr...

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Autores principales: Santoro, Amato, Landra, Federico, Marallo, Carmine, Taddeucci, Simone, Sisti, Nicolò, Pica, Andrea, Stefanini, Andrea, Tavera, Maria Cristina, Pagliaro, Antonio, Baiocchi, Claudia, Cameli, Matteo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10146594/
https://www.ncbi.nlm.nih.gov/pubmed/37103048
http://dx.doi.org/10.3390/jcdd10040169
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author Santoro, Amato
Landra, Federico
Marallo, Carmine
Taddeucci, Simone
Sisti, Nicolò
Pica, Andrea
Stefanini, Andrea
Tavera, Maria Cristina
Pagliaro, Antonio
Baiocchi, Claudia
Cameli, Matteo
author_facet Santoro, Amato
Landra, Federico
Marallo, Carmine
Taddeucci, Simone
Sisti, Nicolò
Pica, Andrea
Stefanini, Andrea
Tavera, Maria Cristina
Pagliaro, Antonio
Baiocchi, Claudia
Cameli, Matteo
author_sort Santoro, Amato
collection PubMed
description Background: Cardiac resynchronization therapy (CRT) is usually performed with biventricular pacing (BiVP), but recently, conduction system pacing (CSP) has been proposed as an alternative in case of BiVP failure. The aim of this study is to define an algorithm to choose between BiVP and CSP resynchronization using the interventricular conduction delays (IVCD) as a guide. Methods: Consecutive patients from January 2018 to December 2020 with an indication for CRT were prospectively enrolled in the study group (delays-guided resynchronization group, DRG). A treatment algorithm based on IVCD was used to decide whether to leave the left ventricular (LV) lead to perform BiVP or pull it out and perform CSP. Outcomes from the DRG group were compared to a historical cohort of CRT patients who underwent CRT procedures between January 2016 and December 2017 (resynchronization standard guide group, SRG). The primary endpoint was a composite of cardiovascular mortality, heart failure (HF) hospitalization, or HF event at 1 year after the date of intervention. Results: The study population consisted of 292 patients, of which 160 (54.8%) were in the DRG and 132 (45.2%) in the SRG. In the DRG, 41 of 160 patients underwent CSP based on the treatment algorithm (25.6%). The primary endpoint was significantly higher in the SRG (48/132, 36.4%) compared to the DRG (35/160, 21.8%) (hazard ratio (HR): 1.72; 95% confidence interval (CI): 1.12–2.65; p = 0.013). Conclusions: A treatment algorithm based on IVCD shifted one patient out of every four from BiVP to CSP, with consequent reduction in the primary endpoint after implantation. Therefore, its application could be useful to determine whether to perform BiVP or CSP.
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spelling pubmed-101465942023-04-29 Biventricular or Conduction System Pacing for Cardiac Resynchronization Therapy: A Strategy for Cardiac Resynchronization Based on a Hybrid Approach Santoro, Amato Landra, Federico Marallo, Carmine Taddeucci, Simone Sisti, Nicolò Pica, Andrea Stefanini, Andrea Tavera, Maria Cristina Pagliaro, Antonio Baiocchi, Claudia Cameli, Matteo J Cardiovasc Dev Dis Article Background: Cardiac resynchronization therapy (CRT) is usually performed with biventricular pacing (BiVP), but recently, conduction system pacing (CSP) has been proposed as an alternative in case of BiVP failure. The aim of this study is to define an algorithm to choose between BiVP and CSP resynchronization using the interventricular conduction delays (IVCD) as a guide. Methods: Consecutive patients from January 2018 to December 2020 with an indication for CRT were prospectively enrolled in the study group (delays-guided resynchronization group, DRG). A treatment algorithm based on IVCD was used to decide whether to leave the left ventricular (LV) lead to perform BiVP or pull it out and perform CSP. Outcomes from the DRG group were compared to a historical cohort of CRT patients who underwent CRT procedures between January 2016 and December 2017 (resynchronization standard guide group, SRG). The primary endpoint was a composite of cardiovascular mortality, heart failure (HF) hospitalization, or HF event at 1 year after the date of intervention. Results: The study population consisted of 292 patients, of which 160 (54.8%) were in the DRG and 132 (45.2%) in the SRG. In the DRG, 41 of 160 patients underwent CSP based on the treatment algorithm (25.6%). The primary endpoint was significantly higher in the SRG (48/132, 36.4%) compared to the DRG (35/160, 21.8%) (hazard ratio (HR): 1.72; 95% confidence interval (CI): 1.12–2.65; p = 0.013). Conclusions: A treatment algorithm based on IVCD shifted one patient out of every four from BiVP to CSP, with consequent reduction in the primary endpoint after implantation. Therefore, its application could be useful to determine whether to perform BiVP or CSP. MDPI 2023-04-14 /pmc/articles/PMC10146594/ /pubmed/37103048 http://dx.doi.org/10.3390/jcdd10040169 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Santoro, Amato
Landra, Federico
Marallo, Carmine
Taddeucci, Simone
Sisti, Nicolò
Pica, Andrea
Stefanini, Andrea
Tavera, Maria Cristina
Pagliaro, Antonio
Baiocchi, Claudia
Cameli, Matteo
Biventricular or Conduction System Pacing for Cardiac Resynchronization Therapy: A Strategy for Cardiac Resynchronization Based on a Hybrid Approach
title Biventricular or Conduction System Pacing for Cardiac Resynchronization Therapy: A Strategy for Cardiac Resynchronization Based on a Hybrid Approach
title_full Biventricular or Conduction System Pacing for Cardiac Resynchronization Therapy: A Strategy for Cardiac Resynchronization Based on a Hybrid Approach
title_fullStr Biventricular or Conduction System Pacing for Cardiac Resynchronization Therapy: A Strategy for Cardiac Resynchronization Based on a Hybrid Approach
title_full_unstemmed Biventricular or Conduction System Pacing for Cardiac Resynchronization Therapy: A Strategy for Cardiac Resynchronization Based on a Hybrid Approach
title_short Biventricular or Conduction System Pacing for Cardiac Resynchronization Therapy: A Strategy for Cardiac Resynchronization Based on a Hybrid Approach
title_sort biventricular or conduction system pacing for cardiac resynchronization therapy: a strategy for cardiac resynchronization based on a hybrid approach
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10146594/
https://www.ncbi.nlm.nih.gov/pubmed/37103048
http://dx.doi.org/10.3390/jcdd10040169
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