Cardiac resynchronization therapy in the real world: need to upgrade outcome research

Left atrial volume index predicts response to cardiac resynchronisation therapy: a systematic review and meta-analysis

“…The regression of atrial arrhythmia with CRT treatment has been interpreted on the basis of reversed LA cavity remodelling [33]. Despite those suggestions, the exact relationships between LA volume response to CRT and other conventional markers of cardiac response are still not established [9][10][11]. This meta-analysis evaluates the relationship between LA cavity measurements and those of cardiac response to CRT.…”

“…Responders to CRT treatment have shown strong evidence for improved cardiac performance and also a benefit of reducing atrial arrhythmia, which has been interpreted on the basis of reverse remodelling of the left atrium (LA) [7]. Debate remains, however, regarding the exact explanation of CRT failure in a substantial percentage of patients [8][9][10]. The aim of this meta-analysis was to assess the potential relationship between CRT response and LA volume changes, particularly in patients who respond favourably.…”

2021 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy: Developed by the Task Force on cardiac pacing and cardiac resynchronization therapy of the European Society of Cardiology (ESC) With the special contribution of the European Heart Rhythm Association (EHRA)

“…However, data on the long-term infection rates or lead revisions after CRT upgrade are scarce. 354,355 The first prospective, randomized trial, the BUDAPEST CRT Upgrade study, is still ongoing, but may clarify these questions. 356…”

Cardiomyopathy associated with long‐term right ventricular pacing: an intriguing clinical issue

“…Different strategies for reducing and even avoiding the negative effects of RV apical pacing have been proposed, ranging from algorithms to minimize unnecessary ventricular pacing, to alternative pacing sites, LV pacing, biventricular pacing, and more recently His‐bundle pacing . Although the benefits of cardiac resynchronization therapy are well established in specific settings, the search for physiological pacing is currently characterized by a growing interest in His‐bundle pacing . In a new perspective that takes into account the dynamic characteristics of a pattern of dilated CMP, with LV remodelling as a target for treatments, with important prognostic implications, it becomes important to improve our knowledge on the determinants of partial or complete regression of a CMP associated with long‐standing RV apical pacing in the case of upgrade to a more physiological pacing modality.…”