![]() This was shown by studies utilising decreased shortening with circumferential strain as an indirect measure of myocardial scarring and was also supported by MRI based studies. It is recognised that patients with LV lead placement in scarred regions have increased heart failure hospitalisations and a reduction in survival when compared to patients with LV leads in scar-free areas. Other studies have shown the adverse effect of myocardial scarring, particularly in the posterolateral segment of the LV which is the usual site of LV lead electrode placement. This concept was reproduced with both speckle-tracking radial strain, colour coded TDI and also 3D echocardiographic LV volume curves. This was described using TDI with the longest duration of the pulsed wave (PW) A wave to the E wave. Echo-guided LV lead implantation:įormer studies in CRT echocardiography have shown a relationship between LV reverse remodelling in non-ischaemic cardiomyopathy with concordant LV leads (LV lead placement to the latest contracting area) in relation to segments with delayed mechanical contraction. Development of CRT delivery over the last decade: tailored CRT therapy:Ī number of studies have addressed different techniques in a bid to improve patient selection and to tailor CRT, thus resulting in an improvement in responder rates which is currently 60-70%. Conduction system pacing (CSP) is an emerging technique to deliver a more physiological pattern of ventricular pacing by directly stimulating the conduction system (bundle of His or more recently left bundle) than the tradition method of CRT with BVP. BVP results in only modest reduction in ventricular activation time and is only beneficial in patients with prolonged QRS reduction, especially left bundle branch block (LBBB). Furthermore, approximately 30% of those receiving CRT with BVP do not experience significant improvement and some even worsen. The development of new tools and techniques has improved success rates of LV lead implantation, but this aspect of the procedure is still a limiting step to BVP. Biventricular pacing (BVP) is the most established form of CRT and has been shown to significantly improve morbidity and mortality in patients with heart failure. ![]() It aims to improve cardiac function by delivering a more physiological pattern of ventricular pacing. Cardiac resynchronisation therapy (CRT) remains an important treatment for patients with heart failure with reduced ejection fraction and inter-ventricular dyssynchrony.
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