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Advances in Cardiac Resynchronization Treatment
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Advances in Cardiac Resynchronization Treatment

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Cardiology".

Deadline for manuscript submissions: 30 June 2025 | Viewed by 4266

Special Issue Editors

Dr. George Leventopoulos

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Guest Editor
Department of Cardiology, University Hospital of Patras, 26504 Rio, Patras, Greece
Interests: atrial fibrillation ablation; ventricular tachycardia ablation conduction system pacing; cardiac devices
Special Issues, Collections and Topics in MDPI journals
Prof. Dr. Konstantinos A. Gatzoulis

E-Mail Website
Guest Editor
First Cardiology Department, National and Kapodistrian University of Athens, Hippokration General Hospital, 11527 Athens, Greece
Interests: cardiac electrophysiology; risk stratification for sudden cardiac death; cardiac devices; ablation
Prof. Dr. Nikolaos K. Fragakis

E-Mail Website
Guest Editor
Second Department of Cardiology, Hippokration General Hospital, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece
Interests: arrhythmias; supraventricular tachycardia; syncope; bradycardia; ventricular arrhythmias; sudden cardiac death (SCD); atrial fibrillation; heart failure
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Resynchronization treatment has changed over the last few years with the advent of novel technologies. Moreover, conduction system pacing has become widely accepted by electrophysiologists. Such procedures now merit more theoretical background and specific equipment with a view and vision to evolve and change the conventional resynchronization treatment means. Preliminary data already suggests that electrical resynchronization is superior to the one achieved by biventricular pacing. Numerous randomized studies are in progress in order to provide us with robust data on this field. There are different aspects in which conduction system pacing can be helpful. It is not only in bailout cases where a difficult coronary sinus anatomy hinders the implantation of a left ventricular lead. There is preliminary data indicating that this novel method can be used a) in the index resynchronization procedure; b) to reverse pacing-induced cardiomyopathy and c) to render patients responders to resynchronization treatment in cases where this was not achieved by the current traditional strategy. Apart from this, emerging techniques promise resynchronization with the use of leadless devices. Novelty is not limited to emerging, cutting-edge technology but also focuses on sudden cardiac death risk stratification. It is a long-standing debate whether patients should receive a defibrillator along with a biventricular device. It seems that it is time to shift the decision-making process by applying a multifactorial risk stratification model. This effort will introduce a more individualized approach and stratify patients not solely based on systolic function, as it stands now for primary prevention under current guidelines. This multi-step strategy is supposed to detect a group of patients that are essentially at risk, but defibrillator treatment is underutilized due to the current gap in evidence. The scope of this Special Issue is to address the aforementioned topics through original investigations and review articles.

Dr. George Leventopoulos
Prof. Dr. Konstantinos A. Gatzoulis
Prof. Dr. Nikolaos K. Fragakis
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • conduction system
  • risk stratification
  • resynchronization
  • cardiac pacing
  • sudden cardiac death

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Published Papers (4 papers)

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Research

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16 pages, 952 KiB  
Article
His Bundle Pacing Improves Left Ventricular Function in Patients with Bradyarrhythmia or Tachy-Brady Syndrome and Permanent Atrial Fibrillation: A Retrospective Analysis
by Patrycja Paluszkiewicz, Adrian Martuszewski, Jacek Smereka and Jacek Gajek
J. Clin. Med. 2025, 14(9), 2860; https://doi.org/10.3390/jcm14092860 - 22 Apr 2025
Viewed by 356
Abstract
Background: Permanent atrial fibrillation (AF) frequently coexists with heart failure (HF), leading to structural remodeling and progressive sinus node dysfunction. As the condition advances, bradyarrhythmia or tachy-brady syndrome may develop. Right ventricular pacing and cardiac resynchronization therapy may impair left ventricular function [...] Read more.
Background: Permanent atrial fibrillation (AF) frequently coexists with heart failure (HF), leading to structural remodeling and progressive sinus node dysfunction. As the condition advances, bradyarrhythmia or tachy-brady syndrome may develop. Right ventricular pacing and cardiac resynchronization therapy may impair left ventricular function due to non-physiological ventricular activation. His bundle pacing (HBP) offers a more physiological alternative. This study evaluates HBP’s impact on left ventricular function in patients with bradyarrhythmia or tachy-brady syndrome and permanent AF. Methods: A retrospective analysis included 41 patients with HF who underwent HBP implantation due to bradyarrhythmia or tachy-brady syndrome in permanent AF. LVEF, LVEDD, and MR were assessed before and after implantation, alongside the impact of comorbidities (e.g., ischemic heart disease and chronic kidney disease) and pharmacotherapy (digoxin, metoprolol, and mineralocorticoid receptor antagonists). Statistical analyses included the Wilcoxon test (LVEF and MR), paired Student’s t-test (LVEDD), Spearman’s correlation, and linear regression. Significance was set at p < 0.05. Results: HBP significantly improved LVEF (median increase: 14.58%; p < 0.001) and reduced LVEDD (mean reduction: 5.41 ± 1.30 mm; p < 0.001). MR severity also decreased (p < 0.001). Patients with lower baseline LVEF showed greater improvement in this parameter after HBP (ρ = −0.671, p < 0.001). Only chronic kidney disease was associated with a lower likelihood of MR improvement (p = 0.0486). Conclusions: HBP improves left ventricular function and reduces MR severity in patients with permanent AF and bradyarrhythmia or tachy-brady syndrome. A low baseline LVEF was the strongest predictor of subsequent improvement. Further studies are needed to confirm long-term benefits. Full article
(This article belongs to the Special Issue Advances in Cardiac Resynchronization Treatment)
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Review

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22 pages, 2206 KiB  
Review
Cardiac Resynchronization Therapy and Conduction System Pacing
by Thomas Garvey O’Neill, Takahiro Tsushima and Bhupendar Tayal
J. Clin. Med. 2025, 14(9), 3212; https://doi.org/10.3390/jcm14093212 - 6 May 2025
Viewed by 305
Abstract
Left bundle branch block (LBBB), initially described in the early 20th century, has become increasingly recognized as one of the leading causes of advanced heart failure (HF). In addition to rapidly growing data on guideline-directed medical therapy, cardiac resynchronization therapy (CRT) via transvenous [...] Read more.
Left bundle branch block (LBBB), initially described in the early 20th century, has become increasingly recognized as one of the leading causes of advanced heart failure (HF). In addition to rapidly growing data on guideline-directed medical therapy, cardiac resynchronization therapy (CRT) via transvenous coronary sinus lead has been the gold-standard therapy, but one-third of the indicated patients do not receive the expected benefits. Recently, cardiac conduction system pacing (CSP) was identified as an alternative to traditional CRT strategy, and multiple data have been published during the last few years. This review will discuss the diagnostic criteria of LBBB and its relation to the development of HF and review available data for traditional CRT as well as CSP in depth. Full article
(This article belongs to the Special Issue Advances in Cardiac Resynchronization Treatment)
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22 pages, 2791 KiB  
Review
Recent Advances in Cardiac Resynchronization Therapy: Current Treatment and Future Direction
by Arsalan Siddiqui, Vasiliki Tasouli-Drakou, Marc Ringor, Michael V. DiCaro, Brianna Yee, KaChon Lei and Tahir Tak
J. Clin. Med. 2025, 14(3), 889; https://doi.org/10.3390/jcm14030889 - 29 Jan 2025
Viewed by 1612
Abstract
Cardiac Resynchronization Therapy (CRT) has been established as a major component of heart failure management, resulting in a significant reduction in patient morbidity and death for patients with increased QRS duration, low left ventricular ejection fraction (LVEF), and high risk of arrhythmias. The [...] Read more.
Cardiac Resynchronization Therapy (CRT) has been established as a major component of heart failure management, resulting in a significant reduction in patient morbidity and death for patients with increased QRS duration, low left ventricular ejection fraction (LVEF), and high risk of arrhythmias. The ability to synchronize both ventricles, lower heart failure hospitalizations, and optimize clinical outcomes are some of the attractive characteristics of biventricular pacing, or CRT. However, the high rate of CRT non-responders has led to the development of new modalities including leadless CRT pacemakers (CRT-P) and devices focused on conduction system pacing (CSP). This comprehensive review aims to present recent findings from CRT clinical trials and systematic reviews that have been published that will likely guide future directions in patient care. Full article
(This article belongs to the Special Issue Advances in Cardiac Resynchronization Treatment)
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Other

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14 pages, 2670 KiB  
Systematic Review
The Effect of Cardiac Resynchronization Therapy on Right Ventricular Function: A Systematic Review and Meta-Analysis
by Georgios Sidiropoulos, Paschalis Karakasis, Antonios Antoniadis, Athanasios Saplaouras, Theodoros Karamitsos and Nikolaos Fragakis
J. Clin. Med. 2024, 13(14), 4173; https://doi.org/10.3390/jcm13144173 - 16 Jul 2024
Cited by 1 | Viewed by 1330
Abstract
Background: Right ventricular (RV) failure is an important predicting factor regarding overall and event-free survival regardless of baseline left ventricular (LV) function in patients with severe heart failure (HF). Previous studies have indicated that cardiac resynchronization therapy (CRT) improves LV and RV [...] Read more.
Background: Right ventricular (RV) failure is an important predicting factor regarding overall and event-free survival regardless of baseline left ventricular (LV) function in patients with severe heart failure (HF). Previous studies have indicated that cardiac resynchronization therapy (CRT) improves LV and RV reverse remodeling in patients with systolic dyssynchrony within the left ventricle. However, there is conflicting evidence regarding the role of CRT in RV function. The aim of this systematic review and meta-analysis was to examine the implications of CRT on RV function indices. Methods: A systematic literature search was conducted using the MedLine and EMBASE databases and the Cochrane Library from their inception until 18 March 2024. Eligible were studies providing information on RV function indices, both at baseline and after CRT. Evidence was summarized using random-effects meta-analytic models. Results: In total, 30 studies were deemed eligible. CRT resulted in a significant improvement in right ventricular fractional area change (mean difference (MD) 5.11%, 95% confidence interval (CI) 2.83 to 7.39), tricuspid annular plane systolic excursion (TAPSE, MD 1.63 mm, 95% CI 1.10 to 2.16), and myocardial systolic excursion velocity (MD 1.85 cm/s, 95% CI 1.24 to 2.47) as well as a significant decrease in pulmonary artery systolic pressure (MD −6.24 mmHg, 95% CI −8.32 to −4.16). A non-significant effect was observed on TAPSE to PASP ratio and right ventricular global longitudinal strain. Conclusions: Our meta-analysis demonstrates that CRT is associated with a significant improvement in echocardiographic parameters of RV function. Further investigation is necessary to elucidate how these changes, both independently and in conjunction with LV improvement, impact patients’ long-term prognosis, and to identify the specific patient populations expected to derive the greatest benefit. Full article
(This article belongs to the Special Issue Advances in Cardiac Resynchronization Treatment)
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