![]() ![]() In comparison with BiV-CRT and HBP, LBBaP has a lower and more stable pacing capture threshold, a higher success rate of implantation, a shorter learning curve, and greater economic feasibility ( 24, 25). ![]() BiV-CRT has shown that LBBaP-CRT could achieve better LVEF improvement than BiV-CRT in heart failure patients with non-ischemic cardiomyopathy and left bundle branch block (LBBB) ( 23). The result of latest, prospective, randomized study of LBBaP-CRT vs. Meanwhile, mounting evidence indicates that LBBaP appears to be an effective method for CRT, and is associated with improvements of symptoms and cardiac function ( 19– 22). It is encouraging that a novel physiological pacing strategy, LBBaP that has emerged in recent years has significant advantages ( 18) ( Figures 1C, F). However, the poor sensing amplitude, the increase of pacing threshold over time, and the inability of the implantation site to cross the block site are the disadvantages associated with HBP, which limit the wide application of HBP to all patients with pacing and CRT indications ( 3, 17). ( 2)-can achieve similar electrical synchronization and LVEF improvement ( 7). Compared to BiV-CRT, HBP-the real physiological pacing modality first reported by Deshmukh et al. Therefore, physiological pacing techniques that directly activate the specialized conduction system are gaining increasing popularity ( Figures 1B, E). In addition, the failure rate range between 7.5 and 10% due to left ventricle scars and coronary vein stenosis or deformity such as diffcult coronary sinus access, tortuous and stenotic venous branches and tiny venous branches ( 10– 13), and about 30–40% of patients do not respond to BiV-CRT due to lead instability, increased pacing thresholds, and phrenic nerve stimulation ( 14– 16). However, the electrical synchrony restored by traditional BiV is not physiological, as it is achieved by variable fusion of wavefronts propagating from the endocardium and epicardium ( 9). Improving cardiac function and reducing the mortality of these patients ( 4– 6) ( Figures 1A, D). His bundle pacing (HBP) and left bundle branch area pacing (LBBaP) are both physiological pacing techniques ( 2, 3).Ī large number of studies have shown that the traditional BiV-CRT can effectively correct the asynchrony of electromechanical activity in heart failure patients, thereby The strategies for achieving cardiac resynchronization include biventricular-CRT (BiV-CRT) and physiological pacing. In this literature review, we summarize the success rates, challenges, and troubleshooting of LBBaP in heart failure patients needing a CRT.Ĭardiac resynchronization therapy (CRT) is an important treatment of heart failure patients with reduced left ventricular ejection fraction (LVEF) and asynchrony of cardiac electromechanical activity ( 1). However, LBBaP is not suitable for all heart failure patients needing a CRT and the success rates of LBBaP in heart failure patients is lower because of myocardial fibrosis, non-specific intraventricular conduction disturbance (IVCD), enlargement of the right atrium or right ventricle, etc. ![]() LBBaP has several advantages over the traditional biventricular-CRT (BiV-CRT), including a low and stable pacing capture threshold, a high success rate of implantation, a short learning curve, and high economic feasibility. Left bundle branch area pacing (LBBaP) is a novel physiological pacing modality that appears to be an effective method for CRT.
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