Optimal Cardiac Resynchronization Therapy with Conduction System Pacing Guided by Electro-Anatomical Mapping: A Case Report

被引:1
|
作者
Pestrea, Catalin [1 ,2 ]
Enache, Roxana [1 ]
Cicala, Ecaterina [1 ]
Vatasescu, Radu [3 ,4 ]
机构
[1] Brasov Cty Clin Emergency Hosp, Intervent Cardiol Unit, Brasov 500326, Romania
[2] Transilvania Univ Brasov, Fac Med, Dept Med & Surg Specialties, Brasov 500019, Romania
[3] Carol Davila Univ Med & Pharm, Fac Med, Bucharest 050474, Romania
[4] Clin Emergency Hosp, Electrophysiol & Cardiac Pacing Lab, Bucharest 014461, Romania
关键词
cardiac resynchronization therapy; His bundle pacing; left bundle branch area pacing; 3D mapping; HEART; SOCIETY;
D O I
10.3390/jcdd10110456
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Introduction: Biventricular pacing has been the gold standard for cardiac resynchronization therapy in patients with left bundle branch block and severely reduced left ventricular ejection fraction for decades. However, in the past few years, this role has been challenged by the promising results of conduction system pacing in these patients, which has proven non-inferior and, at times, superior to biventricular pacing regarding left ventricular function outcomes. One of the most important limitations of both procedures is the long fluoroscopy times. Case description: We present the case of a 60-year-old patient with non-ischemic dilated cardiomyopathy and left bundle branch block in whom conduction system pacing was chosen as the first option for resynchronization therapy. A 3D electro-anatomical mapping system was used to guide the lead to the His bundle region, where correction was observed at high amplitudes, and afterward to the optimal septal penetration site. After reaching the left endocardium, left bundle branch pacing achieved a narrow, paced QRS complex with low fluoroscopy exposure. The three-month follow-up showed a significant improvement in clinical status and left ventricular function. Conclusion: Since conduction system pacing requires a great deal of precision, targeting specific, narrow structures inside the heart, 3D mapping is a valuable tool that increases the chances of success, especially in patients with complex anatomies, such as those with indications for cardiac resynchronization therapy.
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页数:7
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