Pacing interventions in non-responders to cardiac resynchronization therapy

• Published in: Frontiers in Physiology
• Main Authors: Nadeev Wijesuriya, Mark K. Elliott, Vishal Mehta, Felicity De Vere, Marina Strocchi, Jonathan M. Behar, Steven A. Niederer, Christopher A. Rinaldi
• Format: Article
• Language: English
• Published: Frontiers Media S.A. 2023-01-01
• Subjects: CRT; CRT non-response; endocardial pacing; leadless cardiac resynchronization therapy; conduction system pacing
• Online Access: https://www.frontiersin.org/articles/10.3389/fphys.2023.1054095/full

Non-responders to Cardiac Resynchronization Therapy (CRT) represent a high-risk, and difficult to treat population of heart failure patients. Studies have shown that these patients have a lower quality of life and reduced life expectancy compared to those who respond to CRT. Whilst the first-line treatment for dyssynchronous heart failure is “conventional” biventricular epicardial CRT, a range of novel pacing interventions have emerged as potential alternatives. This has raised the question whether these new treatments may be useful as a second-line pacing intervention for treating non-responders, or indeed, whether some patients may benefit from these as a first-line option. In this review, we will examine the current evidence for four pacing interventions in the context of treatment of conventional CRT non-responders: CRT optimization; multisite left ventricular pacing; left ventricular endocardial pacing and conduction system pacing.