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Comparison of left ventricular and biventricular pacing - Rationale and clinical implications [Anatol J Cardiol]
Anatol J Cardiol. Ahead of Print: AJC-35006 | DOI: 10.14744/AnatolJCardiol.2019.35006  

Comparison of left ventricular and biventricular pacing - Rationale and clinical implications

Polychronis Dilaveris, Christos Konstantinos Antoniou, Panagiota Manolakou, Ioannis Skiadas, Konstantinos Konstantinou, Nikolaos Magkas, Panagiotis Xydis, Christina Chrysohoou, Konstantinos Gatzoulis, Dimitrios Tousoulis
1st University Department of Cardiology, Hippokration Hospital, Athens, Greece

Cardiac resynchronization therapy constitutes a cornerstone in advanced heart failure treatment, when there is evidence of dyssynchrony, especially by electrocardiography. However, it is plagued both by persistently high (~30%) rates of nonresponse and by deterioration of right ventricular function, owing to iatrogenic dyssynchrony in the context of persistent apical pacing to ensure delivery of biventricular pacing. Left ventricular pacing has long been considered an alternative to standard biventricular pacing and can be achieved as easily as inserting a single pacing electrode in the coronary sinus. Although monoventricular left ventricular pacing has been proven to yield comparable results with the standard biventricular modality, it is the advent of preferential left ventricular pacing, combining both the powerful resynchronization potential of multipolar coronary sinus and right sided electrodes acting in concert and the ability to preserve intrinsic, physiological right ventricular activation. In the present review, it will be attempted to present the underlying principles and modes for delivering left ventricular pacing, as well as to highlight advantages of preferential over monoventricular configuration. Finally, current clinical evidence, following implementation of automated algorithms, regarding performance of left ventricular as compared with biventricular pacing will be discussed. It is expected that the field of preferential left ventricular pacing will grow significantly over the following years, and its combination with other advanced pacing modalities may promote clinical status and prognosis of advanced dyssynchronous heart failure patients.

Keywords: Dyssynchronous heart failure, cardiac resynchronization therapy, biventricular pacing, preferential left ventricular pacing, right ventricular function


Comparison of left ventricular and biventricular pacing - Rationale and clinical implications

Polychronis Dilaveris, Christos Konstantinos Antoniou, Panagiota Manolakou, Ioannis Skiadas, Konstantinos Konstantinou, Nikolaos Magkas, Panagiotis Xydis, Christina Chrysohoou, Konstantinos Gatzoulis, Dimitrios Tousoulis
1st University Department of Cardiology, Hippokration Hospital, Athens, Greece

Cardiac resynchronization therapy constitutes a cornerstone in advanced heart failure treatment, when there is evidence of dyssynchrony, especially by electrocardiography. However, it is plagued both by persistently high (~30%) rates of nonresponse and by deterioration of right ventricular function, owing to iatrogenic dyssynchrony in the context of persistent apical pacing to ensure delivery of biventricular pacing. Left ventricular pacing has long been considered an alternative to standard biventricular pacing and can be achieved as easily as inserting a single pacing electrode in the coronary sinus. Although monoventricular left ventricular pacing has been proven to yield comparable results with the standard biventricular modality, it is the advent of preferential left ventricular pacing, combining both the powerful resynchronization potential of multipolar coronary sinus and right sided electrodes acting in concert and the ability to preserve intrinsic, physiological right ventricular activation. In the present review, it will be attempted to present the underlying principles and modes for delivering left ventricular pacing, as well as to highlight advantages of preferential over monoventricular configuration. Finally, current clinical evidence, following implementation of automated algorithms, regarding performance of left ventricular as compared with biventricular pacing will be discussed. It is expected that the field of preferential left ventricular pacing will grow significantly over the following years, and its combination with other advanced pacing modalities may promote clinical status and prognosis of advanced dyssynchronous heart failure patients.

Anahtar Kelimeler: Dyssynchronous heart failure, cardiac resynchronization therapy, biventricular pacing, preferential left ventricular pacing, right ventricular function




Corresponding Author: Polychronis Dilaveris, Greece


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