New developments in the delivery of cardiac resynchronization therapy: targeted lead placement, multi-site and endocardial pacing

TY - JOUR

T1 - New developments in the delivery of cardiac resynchronization therapy

T2 - targeted lead placement, multi-site and endocardial pacing

AU - Sohal, Manav

AU - Chen, Zhong

AU - Sammut, Eva

AU - Jackson, Tom

AU - Behar, Jonathan

AU - Carr-White, Gerald

AU - Razavi, Reza

AU - Rinaldi, Aldo

PY - 2014/5

Y1 - 2014/5

N2 - 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.

AB - 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.

KW - cardiac magnetic resonance

KW - cardiac resynchronization therapy

KW - heart failure

KW - image registration

KW - LV endocardial pacing

KW - multi-site pacing

KW - speckle tracking

KW - LEFT-VENTRICULAR LEAD

KW - HEART-FAILURE PATIENTS

KW - FOLLOW-UP

KW - DILATED CARDIOMYOPATHY

KW - TRANSMURAL DISPERSION

KW - CORONARY-SINUS

KW - QT INTERVAL

KW - TASK-FORCE

KW - STIMULATION

KW - TRIAL

U2 - 10.1586/17434440.2014.885320

DO - 10.1586/17434440.2014.885320

M3 - Literature review

SN - 1743-4440

VL - 11

SP - 295

EP - 304

JO - Expert Review Of Medical Devices

JF - Expert Review Of Medical Devices

IS - 3

ER -