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Conduction system pacing, a European survey: insights from clinical practice
D. Keene, F. Anselme, H. Burri, ÓC. Pérez, K. Čurila, M. Derndorfer, P. Foley, L. Gellér, M. Glikson, W. Huybrechts, M. Jastrzebski, K. Kaczmarek, G. Katsouras, J. Lyne, PP. Verdú, C. Restle, S. Richter, S. Timmer, K. Vernooy, Z. Whinnett
Language English Country England, Great Britain
Document type Randomized Controlled Trial, Journal Article
NLK
Free Medical Journals
from 1999 to 1 year ago
PubMed Central
from 2008
Open Access Digital Library
from 1999-01-01
Medline Complete (EBSCOhost)
from 1999-01-01
Oxford Journals Open Access Collection
from 1999-01-01
- MeSH
- Bundle-Branch Block diagnosis therapy MeSH
- Ventricular Function, Left MeSH
- Humans MeSH
- Heart Conduction System MeSH
- Arrhythmias, Cardiac therapy MeSH
- Cardiac Resynchronization Therapy * MeSH
- Heart Failure * diagnosis therapy MeSH
- Stroke Volume physiology MeSH
- Treatment Outcome MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
- Randomized Controlled Trial MeSH
AIMS: The field of conduction system pacing (CSP) is evolving, and our aim was to obtain a contemporary picture of European CSP practice. METHODS AND RESULTS: A survey was devised by a European CSP Expert Group and sent electronically to cardiologists utilizing CSP. A total of 284 physicians were invited to contribute of which 171 physicians (60.2%; 85% electrophysiologists) responded. Most (77%) had experience with both His-bundle pacing (HBP) and left bundle branch area pacing (LBBAP). Pacing indications ranked highest for CSP were atrioventricular block (irrespective of left ventricular ejection fraction) and when coronary sinus lead implantation failed. For patients with left bundle branch block (LBBB) and heart failure (HF), conventional biventricular pacing remained first-line treatment. For most indications, operators preferred LBBAP over HBP as a first-line approach. When HBP was attempted as an initial approach, reasons reported for transitioning to utilizing LBBAP were: (i) high threshold (reported as >2 V at 1 ms), (ii) failure to reverse bundle branch block, or (iii) > 30 min attempting to implant at His-bundle sites. Backup right ventricular lead use for HBP was low (median 20%) and predominated in pace-and-ablate scenarios. Twelve-lead electrocardiogram assessment was deemed highly important during follow-up. This, coupled with limitations from current capture management algorithms, limits remote monitoring for CSP patients. CONCLUSIONS: This survey provides a snapshot of CSP implementation in Europe. Currently, CSP is predominantly used for bradycardia indications. For HF patients with LBBB, most operators reserve CSP for biventricular implant failures. Left bundle branch area pacing ostensibly has practical advantages over HBP and is therefore preferred by many operators. Practical limitations remain, and large randomized clinical trial data are currently lacking.
Arrhythmia Unit Department of Cardiology Virgen de la Arrixaca University Hospital Murcia Spain
Cardiology Department Beacon Hospital Dublin Ireland
Department of Cardiology 'F Miulli' Hospital Acquaviva delle Fonti Bari Italy
Department of Cardiology Centre Hospitalier Universitaire de Rouen Charles Nicolle Rouen France
Department of Cardiology Northwest Clinics Alkmaar The Netherlands
Department of Cardiology University Hospital Antwerp Edegem Belgium
Department of Cardiology University Hospital of Geneva Geneva Switzerland
Electrocardiology Department Medical University of Lodz Lodz Poland
National Heart and Lung Institute Imperial College London Du Cane Road London W12 UK
Semmelweis University Cardiovascular Center Budapest Hungary
Wiltshire Cardiac Centre Great Western Hospitals NHS Foundation Trust Swindon UK
References provided by Crossref.org
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