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Cardiac resynchronization therapy using permanent His-bundle pacing: Are we there yet?

      Biventricular pacing (BVP) was initially developed as an electrical therapy for patients having advanced heart failure with reduced ejection fraction (EF), left bundle branch block (LBBB), and delayed activation of the lateral left ventricular (LV) wall. Cardiac resynchronization therapy (CRT) using BVP significantly improves LV function, clinical outcomes, and survival in this group of patients. The response rate and the magnitude of response to BVP can vary significantly.
      • Epstein A.E.
      • DiMarco J.P.
      • Ellenbogen K.A.
      • et al.
      2012 ACCF/AHA/HRS focused update incorporated into the ACCF/AHA/HRS2008 guidelines for device-based therapy of cardiac rhythm abnormalities: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society.
      Ploux et al
      • Ploux S.
      • Eschalier R.
      • Whinnett Z.I.
      • et al.
      Electrical dyssynchrony induced by biventricular pacing: implications for patient selection and therapy improvement.
      have shown that BVP does not eliminate electrical dyssynchrony induced by LBBB but results in moderate reduction in LV activation times, which are still significantly longer than those observed during normal QRS. This finding suggests that there is significant potential for improvement in CRT.
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