Letter from the Editor in Chief
DOI: 10.19102/icrm.2023.14011
MOUSSA MANSOUR, MD, FHRS, FACC
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Dr. Mansour reports the reception of research grants from Abbott Laboratories, Biosense Webster, Johnson & Johnson, Boston Scientific, Medtronic, Pfizer, Boehringer Ingelheim, and SentreHeart. He is also a consultant for Abbott Laboratories, Biosense Webster, Johnson & Johnson, Boston Scientific, Janssen, Medtronic, Phillips, Novartis, and SentreHeart and reports an equity relationship with EPS Solutions. All aforementioned relationships are in the area of atrial fibrillation; Dr. Mansour additionally reports an equity relationship in the area of ventricular fibrillation with NewPace Ltd.
Dear readers,
Cardiac resynchronization therapy (CRT) is a primary treatment for patients with congestive heart failure (CHF) and conduction system disease. The benefit of this treatment modality has been demonstrated in many studies. Yet, despite many years of research and technological advances, a significant number of patients still do not experience improvement after CRT, and some studies estimate the percentage of non-responders to be >30%.
Over the years, different approaches have been used to improve the selectivity of the targeting areas in the left ventricle (LV) that would result in maximum resynchronization. One approach is electrical-based and aims to target areas of latest activation in the LV. Along this line, a novel technology, electrical dyssynchrony mapping, was recently described.1 It consists of acquiring a modified surface electrogram and generating dyssynchrony maps. Based on these maps, CRT optimization, including right and ventricular differential pacing, could be modified to improve electrical synchrony, which led to an improvement in LV ejection fraction. Another approach is mechanical-based and aims to pace areas of latest contraction in the LV. Identifying the areas of latest contraction has been conventionally guided by echocardiography. In this issue of The Journal of Innovations in Cardiac Rhythm Management, Abdellatif et al.2 describe the use of single-photon emission computed tomography for the identification of the areas of latest contraction and their proximity to the pacing lead to enable the prediction of CRT response.
Both electrical- and mechanical-based approaches to LV lead placement have led to only a small improvement in the rate of non-responders. The lack of a full response is probably due to the limitations imposed by the anatomy of the coronary venous tree rather than the knowledge of where to pace the LV. As a result, more focus should be directed toward the discovery of novel pacing technologies that overcome unsuitable coronary anatomies, including direct LV pacing, physiologic pacing, and others.
Sincerely,
Moussa Mansour, MD, FHRS, FACC
Editor in Chief
The Journal of Innovations in Cardiac Rhythm Management
Director, Atrial Fibrillation Program
Jeremy Ruskin and Dan Starks Endowed Chair in Cardiology
Massachusetts General Hospital
Boston, MA 02114
References
- Brown CD, Burns KV, Harbin MM, et al. Cardiac resynchronization therapy optimization in nonresponders and incomplete responders using electrical dyssynchrony mapping. Heart Rhythm. 2022;19(12):1965–1973. [CrossRef] [PubMed]
- Abdellatif YA, Onsy AM, Eldemerdash SEH, et al. Prediction of cardiac resynchronization therapy response using quantitative gated myocardial perfusion imaging. J Innov Cardiac Rhythm Manage. 2023;14(1):5313–5321. [CrossRef]
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