Cardiac resynchronization considerations in left bundle branch block
Cardiac resynchronization therapy (CRT) via biventricular pacing (BiVP) is an established treatment for patients with left ventricular systolic heart failure and intraventricular conduction delay resulting in wide QRS. Seminal trials demonstrating mortality benefit from CRT were conducted in patient...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2022-09-01
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| Series: | Frontiers in Physiology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fphys.2022.962042/full |
| _version_ | 1798033834838589440 |
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| author | Nathan W. Kong Gaurav A. Upadhyay |
| author_facet | Nathan W. Kong Gaurav A. Upadhyay |
| author_sort | Nathan W. Kong |
| collection | DOAJ |
| description | Cardiac resynchronization therapy (CRT) via biventricular pacing (BiVP) is an established treatment for patients with left ventricular systolic heart failure and intraventricular conduction delay resulting in wide QRS. Seminal trials demonstrating mortality benefit from CRT were conducted in patients with wide left bundle branch block (LBBB) pattern on electrocardiogram (ECG) and evidence of clinical heart failure. The presence of conduction block was assumed to correlate with commonly applied criteria for LBBB. More recent data has challenged this assertion, revealing that LBBB pattern may include distinct underlying pathophysiology, including patients with complete conduction block, either at the left-sided His fibers or the proximal left bundle, intact Purkinje activation with wide LBBB-like QRS, and patients demonstrating both proximal block and distal delay. Currently, BiVP-CRT is indicated for all QRS duration ≥150 ms and may be considered for BBB patterns from 130 to 149 ms with robust clinical data to support its use. Despite this, however, there remains a significant number of non-responders to BVP. Conduction system pacing (CSP) has emerged as an alternative approach to deliver CRT and correct QRS in patients with conduction block. Newer hybrid approaches which combine CSP and traditional BiVP-CRT and may hold promise for patients with IP or mixed-level block. As various approaches to CRT continue to be studied, physiologic phenotyping of the LBBB pattern remains an important consideration. |
| first_indexed | 2024-04-11T20:35:52Z |
| format | Article |
| id | doaj.art-37d09606da104ab6a4e2a6cec2914855 |
| institution | Directory Open Access Journal |
| issn | 1664-042X |
| language | English |
| last_indexed | 2024-04-11T20:35:52Z |
| publishDate | 2022-09-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Physiology |
| spelling | doaj.art-37d09606da104ab6a4e2a6cec29148552022-12-22T04:04:22ZengFrontiers Media S.A.Frontiers in Physiology1664-042X2022-09-011310.3389/fphys.2022.962042962042Cardiac resynchronization considerations in left bundle branch blockNathan W. Kong0Gaurav A. Upadhyay1Department of Internal Medicine, University of Chicago Medicine, Chicago, IL, United StatesSection of Cardiology, Center for Arrhythmia Care, University of Chicago Medicine, Chicago, IL, United StatesCardiac resynchronization therapy (CRT) via biventricular pacing (BiVP) is an established treatment for patients with left ventricular systolic heart failure and intraventricular conduction delay resulting in wide QRS. Seminal trials demonstrating mortality benefit from CRT were conducted in patients with wide left bundle branch block (LBBB) pattern on electrocardiogram (ECG) and evidence of clinical heart failure. The presence of conduction block was assumed to correlate with commonly applied criteria for LBBB. More recent data has challenged this assertion, revealing that LBBB pattern may include distinct underlying pathophysiology, including patients with complete conduction block, either at the left-sided His fibers or the proximal left bundle, intact Purkinje activation with wide LBBB-like QRS, and patients demonstrating both proximal block and distal delay. Currently, BiVP-CRT is indicated for all QRS duration ≥150 ms and may be considered for BBB patterns from 130 to 149 ms with robust clinical data to support its use. Despite this, however, there remains a significant number of non-responders to BVP. Conduction system pacing (CSP) has emerged as an alternative approach to deliver CRT and correct QRS in patients with conduction block. Newer hybrid approaches which combine CSP and traditional BiVP-CRT and may hold promise for patients with IP or mixed-level block. As various approaches to CRT continue to be studied, physiologic phenotyping of the LBBB pattern remains an important consideration.https://www.frontiersin.org/articles/10.3389/fphys.2022.962042/fullleft bundle branch blockcardiac resynchronization therapybiventricular pacingconduction system pacingleft bundle branch area pacing |
| spellingShingle | Nathan W. Kong Gaurav A. Upadhyay Cardiac resynchronization considerations in left bundle branch block Frontiers in Physiology left bundle branch block cardiac resynchronization therapy biventricular pacing conduction system pacing left bundle branch area pacing |
| title | Cardiac resynchronization considerations in left bundle branch block |
| title_full | Cardiac resynchronization considerations in left bundle branch block |
| title_fullStr | Cardiac resynchronization considerations in left bundle branch block |
| title_full_unstemmed | Cardiac resynchronization considerations in left bundle branch block |
| title_short | Cardiac resynchronization considerations in left bundle branch block |
| title_sort | cardiac resynchronization considerations in left bundle branch block |
| topic | left bundle branch block cardiac resynchronization therapy biventricular pacing conduction system pacing left bundle branch area pacing |
| url | https://www.frontiersin.org/articles/10.3389/fphys.2022.962042/full |
| work_keys_str_mv | AT nathanwkong cardiacresynchronizationconsiderationsinleftbundlebranchblock AT gauravaupadhyay cardiacresynchronizationconsiderationsinleftbundlebranchblock |