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Povzetek: Conduction system pacing (CSP) is an emerging new method of cardiac resynchronization therapy (CRT), however, one third of patients with left bundle branch block (LBBB) have distal conduction disease, which is not amenable to correction with CSP. There is an emerging need for tailored analysis of ventricular depolarization patterns for patient selection for CRT pacing modality. We retrospectively analyzed 12 lead hrECGs, equivalent dipole (ED) trajectories and standard transthoracic echocardiograms of 18 heart failure patients fulfilling Strauss criteria for LBBB and indication for CRT randomized to the CSP arm of the ongoing CSP-Sync study (NCT05155865). Based on achievement of left bundle branch capture with shortening of left ventricular activation time, 12 patients had proximal LBBB (pLBBB group), and 6 had intact proximal LBBB conduction (dLBBB group) with similar average baseline QRS durations between the groups (179±14 ms in the pLBBB and 165±20 ms in the dLBBB group, p = 0.1). All patients fulfilled the Strauss criteria with no significant difference in the additional criterion (R wave > 0.1 mV in V1; p = 0.7). In the pLBBB group ED trajectory had an initial leftward direction (six vs. zero patients, p = 0.03) with a uniform (12 vs. one patient, p < 0.001) and slower (0.57 ± 0.12 m/s in the pLBBB vs. 0.75 ± 0.15 m/s in the dLBBB group, p = 0.01) velocity. After 6 months the pLBBB group achieved greater relative QRS duration shortening (26% ± 8% vs. 14% ± 9%; p < 0.02) and relative reductions in end left ventricle systolic volumes (41.3% ± 17.6% vs. 15.8% ± 6.1%; p = 0.004) with better improvement in ejection fraction (17.1% ± 11.0% vs. 5.5% ± 1.0%; p = 0.02). The ED trajectories from 12-lead hrECGs could better differentiate patients with proximal or distal LBBB than standard 12-lead ECG alone.
Ključne besede: 12-lead electrocardiography, body surface potential mapping, cardiac resynchronization therapy, conduction system pacing, left bundle branch block
Objavljeno v DiRROS: 06.07.2026; Ogledov: 168; Prenosov: 108
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Povzetek: Aims: Primary prevention patients with ischaemic cardiomyopathy and chronic total occlusion of an infarct-related coronary artery (CTO) are at a particularly high risk of implantable cardioverter-defibrillator (ICD) therapy occurrence. The trial was designed to evaluate the efficacy of preventive CTO-related substrate ablation strategy in ischaemic cardiomyopathy patients undergoing primary prevention ICD implantation. Methods and results: The PREVENTIVE VT study was a prospective, multicentre, randomized trial including ischaemic patients with ejection fraction ≤40%, no documented ventricular arrhythmias (VAs), and evidence of scar related to the coronary CTO. Patients were randomly assigned 1:1 to a preventive substrate ablation before ICD implantation or standard therapy with ICD implantation only. The primary outcome was a composite of appropriate ICD therapy or unplanned hospitalization for VAs. Secondary outcomes included the primary outcome's components, the incidence of appropriate ICD therapies, cardiac hospitalization, electrical storm, and cardiovascular (CV) mortality. Sixty patients were included in the study. During the mean follow-up of 44.7 ± 20.7 months, the primary outcome occurred in 5 (16.7%) patients undergoing preventive substrate ablation and in 13 (43.3%) patients receiving only ICD [hazard ratio (HR): 0.33; 95% confidence interval (CI): 0.12-0.94; P = 0.037]. Patients in the preventive ablation group also had fewer appropriate ICD therapies (P = 0.039) and the electrical storms (Log-rank: P = 0.01). While preventive ablation also reduced cardiac hospitalizations (P = 0.006), it had no significant impact on CV mortality (P = 0.151). Conclusion: Preventive ablation of the coronary CTO-related substrate in patients undergoing primary ICD implantation is associated with the reduced risk of appropriate ICD therapy or unplanned hospitalization due to VAs
Ključne besede: catheter ablation, implantable cardioverter-defibrillator, ischaemic cardiomyopathy, ventricular arrhythmia
Objavljeno v DiRROS: 05.06.2026; Ogledov: 255; Prenosov: 300
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Ključne besede: podedovane aritmije, nenadna srčna smrt, prekatna fibrilacija, kanalčkopatije, kardiomiopatije, kardiologija
Objavljeno v DiRROS: 20.04.2026; Ogledov: 314; Prenosov: 224
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Povzetek: Background and Aims: Left bundle branch area pacing (LBBAP) promotes physiological synchronous activation of the left ventricle and may be particularly beneficial in patients with atrioventricular block (AVB), but its mortality benefit remains unclear. This study aims to compare long-term survival in AVB patients receiving either LBBAP or right ventricular pacing (RVP) and to analyse predictors of mortality during LBBAP. Methods: MELOS RELOADED, a multicentre European collaboration, was a registry-based study of pacemaker patients with AVB, left ventricular ejection fraction (LVEF) >40% and ventricular pacing >20%. The primary outcome was all-cause mortality based on national registries. A 1:1 propensity score matching was performed between the RVP and LBBAP groups. Kaplan–Meier curves and multivariable Cox proportional hazards models were used to estimate survival. Results: In total, 3382 patients receiving LBBAP or RVP were matched. At 4-year follow-up, the Kaplan–Meier curve showed an absolute difference in survival of 11.8% in favour of LBBAP (P < .001). LBBAP was a robust predictor of reduced mortality with a hazard ratio (HR) of 0.53 (95% confidence interval 0.42–0.65, P < .001). Within the LBBAP group, the following independent predictors of increased mortality were identified: lack of confirmed left bundle branch capture (HR 1.85, P < .001), lower percentage of ventricular pacing (HR 1.12), and age. Conclusions: This is the first large study demonstrating the long-term survival benefit of LBBAP. This strengthens the use of LBBAP in AVB patients with preserved/mildly reduced LVEF while awaiting the results of randomized trials. Confirmation of left bundle branch capture seems advisable to achieve optimal results with LBBAP.
Ključne besede: conduction system pacing, left bundle branch area pacing, atrioventricular block, mortality, heart failure
Objavljeno v DiRROS: 10.04.2026; Ogledov: 1120; Prenosov: 312
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Povzetek: Atrial fibrillation and heart failure with preserved ejection fraction (HFpEF) are frequent concomitant diseases sharing several pathophysiological mechanisms leading to structural remodelling of both atria and ventricles. We present a case of an HFpEF patient with rapid atrial fibrillation who remained symptomatic even after successful cardioversion, initiation of antiarrhythmic therapy, and treatment of comorbidities. Due to asymmetric septal hypertrophy, the stress test was performed to exclude outflow tract obstruction and revealed a low basal heart rate with significant chronotropic insufficiency. In addition to SGLT2 initiation, the beta-blocker dose was reduced, and amiodarone was discontinued. This therapy modification led to a marked improvement in exercise capacity, significant reduction of palpitations, reduction of NT-proBNP, and signs of a decreased left ventricular filling pressure with reverse remodelling of LA. This case shows the importance of both individual tailoring of medical therapy and chronotropic insufficiency in HFpEF patients
Ključne besede: atrial fibrillation, heart failure, heart rate, sodium-glucose transporter 2 inhibitors
Objavljeno v DiRROS: 26.02.2026; Ogledov: 411; Prenosov: 300
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