Cardiac Resynchronization Therapy (CRT) is among the most efficient heart failure treatments in patients with a widened QRS complex. Despite large amounts of scientific data on the topic, no direct identifying markers of the underlying mechanisms that lead to heart failure development in such patients have been described. The patient selection is still based on population-based data with minimal emphasis on personalization of treatment or precision medicine. Between 30-50% of all patients treated with CRT have minimal response to therapy and the costs of treatment, therefore, remain high.
The presence of myocardial scar, a QRS ≤150 ms, and the absence of LBBB morphology are all independently associated with a lower likelihood of clinical response to CRT. In this context, simultaneous and sequential left ventricular (LV) multipoint pacing (MPP) may be superior to LV single point pacing (SPP).
Additionally, in LBBB patients further optimization of CRT delivery has been proposed to address the clinically observed sub-optimal response to CRT in some patients. Maximizing LV synchronicity is the ultimate aim of CRT. Adding more LV pacing leads, and thus partitioning the left ventricul into smaller segments has been proposed as a means of improving LV synchronicity.
A biomarker is an accurate and robust measurement that identifies a type of disease or response. A better mechanistic characterization of dyssynchronous heart failure with a biomarker may help identify suitable patients for therapy. Biomarkers may also help phenotypically describe dyssynchronous heart failure and help reduce the costs associated with treatment. As such, a biomarker for dyssynchronous heart failure may have a significant impact on value-based health care to help provide optimal treatment to patients at a lower cost to society. Further to this, CRT could be improved by discovering a biomarker for dyssynchronous heart failure from within the different methods of assessing heart failure in those with a widened QRS complex.
After years of research on small groups of participants, selective pacing of atrioventricular conductive pathways (SAVCPP), has reached its renaissance and has become a hot topic within cardiac pacing, especially in terms of direct His bundle pacing and LBB pacing. There is great interest in connecting outcomes of both CRT and SAVCPP to obtain further improvement in heart failure patients.
European data coming from two ESC/EHRA/HFA registry studies, EuroCRT Survey I and II, showed that LBBB patients are a major group for CRT implementation, while other intraventricular conduction disturbances or up-grades, lost his levels of evidence. Pathways to investigate further pacing improvement to correct dyssynchrony both in LBBB and other, less frequently used, CRT indications are needed and warranted.
SynSeq study* was designed to determine whether in patients with a lower likelihood of response to CRT, simultaneous (3P-MPPsyn) or sequential (3P-MPPseq) 3-point left ventricular (LV) pacing is superior to single point pacing (SPP) in basal, mid or apical LV segments measured by LV dp/dtmax
The MultiVein study was a sub-study of the Left Ventricular MultiSpot pacing for CRT (iSPOT) study*. The hypothesis was that MultiVein stimulation in terms of acute change in positive LV dp/dtmax was non-inferior to standard CRT pacing, which is considered as the standard of care by guidelines.
This topic aims to identify mechanisms underlying the substrate for dyssynchronous heart failure and biomarkers that could improve diagnosis, prediction or point to the prognosis in dyssynchronous heart failure. The topic also aims to use the acute hemodynamic effect of CRT with use of selective recruitment of atrioventricular conductive pathways to determine further improvement of the therapy in heart failure.
*Both studies employed an extremely rigorous and robust invasive protocol with repeated invasive measurements performed at high accuracy (noise minimizing results) with a patient-specific AV-optimization protocol.
This Research Topic specifically welcomes manuscripts on the following subjects:
• Acute changes of LV dP/dt in non-true-LBBB patients with CRT indications by simultaneous or sequential 3-point linear LV pacing vs. single point LV classical CRT pacing
• Acute changes of LV dP/dt in LBBB patients with CRT indications by multivein pacing vs single point LV classical CRT pacing
• Submissions related to the mechanisms underlying the substrate for dyssynchronous heart failure and biomarkers that could improve diagnosis, prediction or point to the prognosis in dyssynchronous heart failure
• Acute hemodynamic effect CRT with use of His bundle or LBB pacing
• Overview of European trends in CRT use over the last two decades as a background for research topics of presented studies
Topic Editor Hans Henrik Odland holds shares in Pacertool (Oslo). Topic Editor Maciej Sterlinski received financial support from Abbott, Biotronik, Boston Scientific, HammerMed, Medtronic and Zoll.
Cardiac Resynchronization Therapy (CRT) is among the most efficient heart failure treatments in patients with a widened QRS complex. Despite large amounts of scientific data on the topic, no direct identifying markers of the underlying mechanisms that lead to heart failure development in such patients have been described. The patient selection is still based on population-based data with minimal emphasis on personalization of treatment or precision medicine. Between 30-50% of all patients treated with CRT have minimal response to therapy and the costs of treatment, therefore, remain high.
The presence of myocardial scar, a QRS ≤150 ms, and the absence of LBBB morphology are all independently associated with a lower likelihood of clinical response to CRT. In this context, simultaneous and sequential left ventricular (LV) multipoint pacing (MPP) may be superior to LV single point pacing (SPP).
Additionally, in LBBB patients further optimization of CRT delivery has been proposed to address the clinically observed sub-optimal response to CRT in some patients. Maximizing LV synchronicity is the ultimate aim of CRT. Adding more LV pacing leads, and thus partitioning the left ventricul into smaller segments has been proposed as a means of improving LV synchronicity.
A biomarker is an accurate and robust measurement that identifies a type of disease or response. A better mechanistic characterization of dyssynchronous heart failure with a biomarker may help identify suitable patients for therapy. Biomarkers may also help phenotypically describe dyssynchronous heart failure and help reduce the costs associated with treatment. As such, a biomarker for dyssynchronous heart failure may have a significant impact on value-based health care to help provide optimal treatment to patients at a lower cost to society. Further to this, CRT could be improved by discovering a biomarker for dyssynchronous heart failure from within the different methods of assessing heart failure in those with a widened QRS complex.
After years of research on small groups of participants, selective pacing of atrioventricular conductive pathways (SAVCPP), has reached its renaissance and has become a hot topic within cardiac pacing, especially in terms of direct His bundle pacing and LBB pacing. There is great interest in connecting outcomes of both CRT and SAVCPP to obtain further improvement in heart failure patients.
European data coming from two ESC/EHRA/HFA registry studies, EuroCRT Survey I and II, showed that LBBB patients are a major group for CRT implementation, while other intraventricular conduction disturbances or up-grades, lost his levels of evidence. Pathways to investigate further pacing improvement to correct dyssynchrony both in LBBB and other, less frequently used, CRT indications are needed and warranted.
SynSeq study* was designed to determine whether in patients with a lower likelihood of response to CRT, simultaneous (3P-MPPsyn) or sequential (3P-MPPseq) 3-point left ventricular (LV) pacing is superior to single point pacing (SPP) in basal, mid or apical LV segments measured by LV dp/dtmax
The MultiVein study was a sub-study of the Left Ventricular MultiSpot pacing for CRT (iSPOT) study*. The hypothesis was that MultiVein stimulation in terms of acute change in positive LV dp/dtmax was non-inferior to standard CRT pacing, which is considered as the standard of care by guidelines.
This topic aims to identify mechanisms underlying the substrate for dyssynchronous heart failure and biomarkers that could improve diagnosis, prediction or point to the prognosis in dyssynchronous heart failure. The topic also aims to use the acute hemodynamic effect of CRT with use of selective recruitment of atrioventricular conductive pathways to determine further improvement of the therapy in heart failure.
*Both studies employed an extremely rigorous and robust invasive protocol with repeated invasive measurements performed at high accuracy (noise minimizing results) with a patient-specific AV-optimization protocol.
This Research Topic specifically welcomes manuscripts on the following subjects:
• Acute changes of LV dP/dt in non-true-LBBB patients with CRT indications by simultaneous or sequential 3-point linear LV pacing vs. single point LV classical CRT pacing
• Acute changes of LV dP/dt in LBBB patients with CRT indications by multivein pacing vs single point LV classical CRT pacing
• Submissions related to the mechanisms underlying the substrate for dyssynchronous heart failure and biomarkers that could improve diagnosis, prediction or point to the prognosis in dyssynchronous heart failure
• Acute hemodynamic effect CRT with use of His bundle or LBB pacing
• Overview of European trends in CRT use over the last two decades as a background for research topics of presented studies
Topic Editor Hans Henrik Odland holds shares in Pacertool (Oslo). Topic Editor Maciej Sterlinski received financial support from Abbott, Biotronik, Boston Scientific, HammerMed, Medtronic and Zoll.