دورية أكاديمية
[New pacing strategies for heart failure].
العنوان: | [New pacing strategies for heart failure]. |
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عنوان ترانسليتريتد: | Neue Pacing-Strategien bei Herzinsuffizienz. |
المؤلفون: | Beyer SE; Klinik für Elektrophysiologie, Herz- und Diabeteszentrum NRW, Ruhr Universität Bochum, Georgstr. 11, 32545, Bad Oeynhausen, Deutschland., Imnadze G; Klinik für Elektrophysiologie, Herz- und Diabeteszentrum NRW, Ruhr Universität Bochum, Georgstr. 11, 32545, Bad Oeynhausen, Deutschland., Sommer P; Klinik für Elektrophysiologie, Herz- und Diabeteszentrum NRW, Ruhr Universität Bochum, Georgstr. 11, 32545, Bad Oeynhausen, Deutschland. psommer@hdz-nrw.de.; Herz- und Diabeteszentrum NRW, Georgstr. 11, 32545, Bad Oeynhausen, Deutschland. psommer@hdz-nrw.de. |
المصدر: | Innere Medizin (Heidelberg, Germany) [Inn Med (Heidelb)] 2024 Aug; Vol. 65 (8), pp. 778-786. Date of Electronic Publication: 2024 Jul 05. |
نوع المنشور: | Journal Article; Review |
اللغة: | German |
بيانات الدورية: | Publisher: Springer Medizin Country of Publication: Germany NLM ID: 9918384885306676 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 2731-7099 (Electronic) Linking ISSN: 27317080 NLM ISO Abbreviation: Inn Med (Heidelb) Subsets: MEDLINE |
أسماء مطبوعة: | Original Publication: [Heidelberg, Germany] : Springer Medizin, [2022]- |
مواضيع طبية MeSH: | Heart Failure*/therapy , Heart Failure*/physiopathology , Cardiac Resynchronization Therapy*/methods, Humans ; Bundle-Branch Block/therapy ; Bundle-Branch Block/physiopathology ; Cardiac Pacing, Artificial/methods ; Quality of Life |
مستخلص: | In patients with a reduced left ventricular (LV) systolic function (ejection fraction < 35%) and a left bundle branch block with a QRS duration > 130 ms, cardiac resynchronization therapy (CRT) can contribute to an improvement in the quality of life and a reduction in mortality. The resynchronization is mostly achieved by pacing via an epicardial LV lead in the coronary sinus; however, this approach is often limited by the patient's venous anatomy and an increase in the stimulation threshold over time. In addition, up to 30% of patients do not respond to the intervention. New treatment approaches involve direct stimulation of the conduction system by pacing of the bundle of His or left bundle branch. This enables a more physiological propagation of the stimulus. Pacing of the left bundle branch is achieved by advancing the lead into the right ventricle and screwing it deep into the interventricular septum. Due to the relatively large target area of the left bundle branch the success rate is very high (currently > 90%). Observational studies have shown a greater reduction in the QRS duration, a more pronounced improvement in systolic function and a lower hospitalization rate for heart failure associated with conduction system pacing compared to CRT using a coronary sinus lead. These findings have been confirmed in small randomized trials. Therefore, the use of left bundle branch pacing should be considered not only as a bail out in the case of failed resynchronization using coronary sinus lead placement but increasingly also as an initial pacing strategy. The results of the first large randomized trials are expected to be released in late 2024. (© 2024. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.) |
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فهرسة مساهمة: | Keywords: Biventricular pacing; Bundle of His; Cardiac conduction system; Cardiac resynchronization therapy; Left bundle branch pacing Local Abstract: [Publisher, German] Bei Patienten mit einer reduzierten systolischen linksventrikulären (LV-)Funktion (Ejektionsfraktion < 35 %) und einem Linksschenkelblock (Breite des QRS-Komplexes > 130 ms) kann eine kardiale Resynchronisationstherapie (CRT) zur Verbesserung der Leistungsfähigkeit und zur Senkung der Mortalität beitragen. Die Resynchronisation wird zumeist durch Stimulation über eine epikardiale LV-Sonde im Koronarsinus erreicht. Diese Therapie ist jedoch häufig durch Variationen des Venensystems des Patienten und durch einen Anstieg der Reizschwelle im Laufe der Zeit limitiert. Zudem sprechen bis zu 30 % der Patienten nicht auf die Intervention an. Neue Therapieansätze beinhalten die direkte Stimulation des Erregungsleitungssystems durch His-Bündel- oder Linksschenkelstimulation. Hierdurch kann eine physiologischere Erregungsausbreitung erzielt werden. Die Linksschenkelstimulation wird durch das Einschrauben einer Sonde in das interventrikuläre Septum vom rechten Ventrikel aus erreicht. Durch das relativ große Zielgebiet des linken Tawara-Schenkels ist die Erfolgsrate sehr hoch (aktuell > 90 %). Beobachtungsstudien zeigen eine im Vergleich zur Resynchronisation mithilfe einer Koronarsinussonde stärkere Reduktion der QRS-Komplex-Breite, eine ausgeprägtere Verbesserung der systolischen Funktion und eine geringere Hospitalisierungsrate der Patienten mit einer Herzinsuffizienz. Ähnliche Ergebnisse finden sich in kleinen randomisierten Studien. Insbesondere die Anwendung der Linksschenkelstimulation wird nicht nur als Ersatz nach dem Scheitern der Resynchronisation mithilfe der Koronarsinussonde, sondern zunehmend auch als initiale Strategie unterstützt. Die Ergebnisse der ersten größeren randomisierten Studien sind ab Ende 2024 zu erwarten. |
تواريخ الأحداث: | Date Created: 20240705 Date Completed: 20240724 Latest Revision: 20240724 |
رمز التحديث: | 20240726 |
DOI: | 10.1007/s00108-024-01747-7 |
PMID: | 38967707 |
قاعدة البيانات: | MEDLINE |
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