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How to treat cardiac dyssynchrony in heart failure with reduced ejection fraction

Stefan Bogdan
Stefan Bogdan
, 
Alexandru Ababei
Alexandru Ababei
 und 
Michael Glikson
Michael Glikson
   | 29. März 2024
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Article Category: Review
Online veröffentlicht: 29. März 2024
Seitenbereich: 1 - 6
DOI: https://doi.org/10.2478/rjc-2023-0027
Schlüsselwörter
© 2023 Stefan Bogdan et al., published by Sciendo
This work is licensed under the Creative Commons Attribution 4.0 International License.

Figure 1

Left ventricular electrical activation patterns: A. intrinsic LBBB; B. biventricular pacing; C. LBBA pacing. AVN, atrioventricular node; CSP, conduction system pacing; LBB, left bundle branch; LBBB, left bundle branch block; LBBAP, left bundle branch area; SAN, sino-atrial node.
Left ventricular electrical activation patterns: A. intrinsic LBBB; B. biventricular pacing; C. LBBA pacing. AVN, atrioventricular node; CSP, conduction system pacing; LBB, left bundle branch; LBBB, left bundle branch block; LBBAP, left bundle branch area; SAN, sino-atrial node.

Figure 2

Cardiac resynchronization therapy: classes of recommendations and level of evidence for biventricular pacing and conduction system pacing according to current guidelines. CRT, cardiac resynchronization therapy; CSP, conduction system pacing (His bundle or left bundle branch area pacing); LBBB, left bundle branch block; OMT, optimal medical therapy. According to 2023 HRS/APHRS/LAHRS Guideline on Cardiac Physiologic Pacing: *120 ms **For female sex: Class of recommendation I, level of evidence A ***For NYHA II: Class of recommendation IIb
Cardiac resynchronization therapy: classes of recommendations and level of evidence for biventricular pacing and conduction system pacing according to current guidelines. CRT, cardiac resynchronization therapy; CSP, conduction system pacing (His bundle or left bundle branch area pacing); LBBB, left bundle branch block; OMT, optimal medical therapy. According to 2023 HRS/APHRS/LAHRS Guideline on Cardiac Physiologic Pacing: *120 ms **For female sex: Class of recommendation I, level of evidence A ***For NYHA II: Class of recommendation IIb

Cardiac electrical dyssynchrony types and functional consequences. Wide QRS, QRS duration > 120 ms; LV, left ventricle; LBBB, left bundle branch block

Type of dyssynchrony Underlying electrical disease Functional consequence
Atrioventricular Prolonged PR/AV block Diastolic impairment
Inter-ventricular Wide QRS Systolic impairment
Intra-ventricular LV Wide QRS (LBBB) Systolic and diastolic impairment Mitral regurgitation

Mechanical intra-left ventricular dyssynchrony evaluation by cardiac echography.[10–16] Ts, time-to-peak systolic velocity; SD, standard deviation; LV, left ventricular; 2D, two dimensional; 3D, three dimensional

Echography parameter Method Cut-off values
Septal to posterior wall motion delay[11] M-mode ≥ 130 ms
Septal flash[12] M-mode Nonquantifiable1
Apical rocking[12] 2D apical 4 chambers Nonquantifiable2
Basal septal to lateral Ts delay[13] Tissue Doppler imaging ≥ 60 ms
Maximum delay in Ts in 4 basal LV segments[14] Tissue Doppler imaging > 65 ms
SD of Ts of 6 basal LV segments[15] Tissue Doppler imaging ≥ 34.4 ms
Antero-septal to posterior time to peak strain difference (radial strain[16] 2D speckle tracking ≥ 130 ms
SD of time to minimum systolic volume of 16 LV segments (systolic dyssynchrony index)[16] 3D echocardiography > 5.6%
eISSN:
2734-6382
Sprache:
Englisch
Zeitrahmen der Veröffentlichung:
4 Hefte pro Jahr
Fachgebiete der Zeitschrift:
Medizin, Klinische Medizin, Allgemeinmedizin, Innere Medizin, Kardiologie, Kinder- und Jugendmedizin, Kinderkardiologie, Chirurgie, Herzchirurgie
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