If your doctor has told you that you need cardiac resynchronization therapy (CTR) see three recent scientific studies suggesting the next generation of CRT. Your doctor may recommend CRT is for what is termed “pacing induced cardiomyopathy.” It is termed “resynchronization therapy,” because it is an attempt to bring the contractions of the left and right ventricles in sync with each other.
If you had a right ventricular lead, resulting in pacing induced cardiomyopathy, your doctor could put in a third lead, reaching out to the left ventricle. Or, according to recent studies (represented by three studies below) a lead can be placed to pace the His-bundle for natural, physiological ventricular resynchronization. The general result of natural, ventricular synchronization is a healthy and strong heartbeat which, according to the literature, has allowed the failing heart to heal itself.
(You may ask, why not pace the His-bundle in the first place and avoid pacing induced heart failure? Good question. Answers vary.)
These three new studies, from 2018 and 2019, add to the volume of results which corroborate the advantages of natural activation of the heartbeat. You may wish to peruse in detail, or review their abstracts.
Conclusion:
His resynchronization delivers better ventricular resynchronization, and greater improvement in hemodynamic parameters, than biventricular pacing.
Conclusion:
Patients receiving His-CRT on-treatment demonstrated superior electrical resynchronization and a trend toward higher echocardiographic response than BiV-CRT.
Conclusion:
Despite a long duration of AVB [Ed., A/V block] and chronic RVP [right ventricular pacing], HBP [His-bundle pacing] normalized QRS complexes and T waves with stable thresholds, suggesting that progression of distal conduction disease is uncommon in this population. Electrical and structural changes induced by chronic RVP were consistently reversed with HBP.
Something which is particularly notable is that in all three instances, normal ventricular activation, starting at the His-bundle, continues to find favor when compared to conventional heart muscle pacing that bypasses the elegant His/Purkinje system. It is any method alternative to the normal activation which sometimes results in “pacing induced cardiomyopathy.” Not to worry, though — follow your ejection fraction with your doctor, as a sign of such impending heart failure.
