Congenitally corrected transposition of the great arteries(CCTGA)is a rare congenital heart disease characterized by atrioventricular,ventriculoarterial,and conduction system discordance,commonly accompanied by atriov...Congenitally corrected transposition of the great arteries(CCTGA)is a rare congenital heart disease characterized by atrioventricular,ventriculoarterial,and conduction system discordance,commonly accompanied by atrioventricular block(AVB).Pacing in patients with CCTGA and AVB(both pediatric and adult)poses challenges in strategy selection,procedural complexity,and clinical decision-making due to limited evidence.Conventional morphological left ventricular pacing is widely adopted but may induce ventricular dyssynchrony,heart failure,and tricuspid valve dysfunction.While cardiac resynchronization therapy serves as an upgrade for pacing-induced cardiomyopathy and heart failure,its application may be limited by coronary sinus anatomical variations and uncertain clinical outcomes.His bundle pacing is rarely reported due to the variation of the His bundle and high pacing threshold.The superficial,wide,multi-branched left bundle branch favors left bundle branch pacing,though delayed systemic right ventricle(sRV)activation may cause ventricular dyssynchrony and impair sRV function.Right bundle branch pacing offers a novel alternative for pacing therapy.Conduction system pacing-optimized cardiac resynchronization therapy is preferred in those with evidence of intrinsic ventricular conduction dysfunction.This narrative review synthesizes current evidence on pacing strategies for CCTGA with AVB,integrating anatomical and pathophysiological insights to evaluate physiological pacing strategies,while highlighting critical knowledge gaps to guide future research.展开更多
BACKGROUND Left bundle branch pacing(LBBP)is a physiological pacing method that has emerged in recent years.It is an ideal choice for patients with complete left bundle branch block who are in need of cardiac resynchr...BACKGROUND Left bundle branch pacing(LBBP)is a physiological pacing method that has emerged in recent years.It is an ideal choice for patients with complete left bundle branch block who are in need of cardiac resynchronization therapy(CRT).Moreover,LBBP is superior in maintaining physiological ventricular activation and can effectively improve heart function and quality of life in patients with pacemaker-induced cardiomyopathy.However,LBBP in pacing-dependent patients who already have cardiac dysfunction has not been well assessed.CASE SUMMARY A 69-year-old male patient presented with symptoms of chest tightness,palpitation and systolic heart failure with New York Heart Association class III for 1 mo.The 12-lead electrocardiogram showed atrial fibrillation with third-degree atrioventricular block and ventricular premature beat.Holter revealed a right bundle branch block,atrial fibrillation with third-degree atrioventricular block,frequent multifocal ventricular premature beats,Ron-T and ventricular tachycardia.The echocardiogram documented an enlarged left atrium and left ventricle and a low left ventricular ejection fraction.Coronary angiography indicated a stenosis of 30%in the middle left anterior descending artery.Apparently,a CRT-D pacemaker was the best choice for this patient according to previous findings.However,the patient was worried about the financial burden.A single-chamber pacemaker with LBBP was selected,with the plan to take amiodarone and upgrade with dual-chamber implantable cardioverter-defibrillator or CRT-D at an appropriate time.During the follow-up at 3 mo after LBBP,the patient showed an improvement in cardiac function with slight improvement in echocardiography parameters,and the New York Heart Association functional class was maintained at I.Moreover,the patient no longer suffered from chest tightness and palpitation.Holter showed decreased ventricular arrhythmia of less than 5%.CONCLUSION LBBP might be used in patients with heart failure and a high-degree atrioventricular block as an alternative to conventional CRT.展开更多
In recent years, the indications of cardiac pacing have extended continuously with the rapid development of pacing technique. Pacemaker treatment has not only limited in arrhythmias of bradycardia and the number of pa...In recent years, the indications of cardiac pacing have extended continuously with the rapid development of pacing technique. Pacemaker treatment has not only limited in arrhythmias of bradycardia and the number of pacemaker treatment has increased year by year. However, more and more new congestive heart failure （ CHF ） and aggravated CHF have appeared in patients after pacing therapy. Therefore, it is a hot topic that how to select reasonable pacing mode to reduce CHF occurrence or relieve CHF symptoms in patients with CHF.展开更多
文摘Congenitally corrected transposition of the great arteries(CCTGA)is a rare congenital heart disease characterized by atrioventricular,ventriculoarterial,and conduction system discordance,commonly accompanied by atrioventricular block(AVB).Pacing in patients with CCTGA and AVB(both pediatric and adult)poses challenges in strategy selection,procedural complexity,and clinical decision-making due to limited evidence.Conventional morphological left ventricular pacing is widely adopted but may induce ventricular dyssynchrony,heart failure,and tricuspid valve dysfunction.While cardiac resynchronization therapy serves as an upgrade for pacing-induced cardiomyopathy and heart failure,its application may be limited by coronary sinus anatomical variations and uncertain clinical outcomes.His bundle pacing is rarely reported due to the variation of the His bundle and high pacing threshold.The superficial,wide,multi-branched left bundle branch favors left bundle branch pacing,though delayed systemic right ventricle(sRV)activation may cause ventricular dyssynchrony and impair sRV function.Right bundle branch pacing offers a novel alternative for pacing therapy.Conduction system pacing-optimized cardiac resynchronization therapy is preferred in those with evidence of intrinsic ventricular conduction dysfunction.This narrative review synthesizes current evidence on pacing strategies for CCTGA with AVB,integrating anatomical and pathophysiological insights to evaluate physiological pacing strategies,while highlighting critical knowledge gaps to guide future research.
文摘BACKGROUND Left bundle branch pacing(LBBP)is a physiological pacing method that has emerged in recent years.It is an ideal choice for patients with complete left bundle branch block who are in need of cardiac resynchronization therapy(CRT).Moreover,LBBP is superior in maintaining physiological ventricular activation and can effectively improve heart function and quality of life in patients with pacemaker-induced cardiomyopathy.However,LBBP in pacing-dependent patients who already have cardiac dysfunction has not been well assessed.CASE SUMMARY A 69-year-old male patient presented with symptoms of chest tightness,palpitation and systolic heart failure with New York Heart Association class III for 1 mo.The 12-lead electrocardiogram showed atrial fibrillation with third-degree atrioventricular block and ventricular premature beat.Holter revealed a right bundle branch block,atrial fibrillation with third-degree atrioventricular block,frequent multifocal ventricular premature beats,Ron-T and ventricular tachycardia.The echocardiogram documented an enlarged left atrium and left ventricle and a low left ventricular ejection fraction.Coronary angiography indicated a stenosis of 30%in the middle left anterior descending artery.Apparently,a CRT-D pacemaker was the best choice for this patient according to previous findings.However,the patient was worried about the financial burden.A single-chamber pacemaker with LBBP was selected,with the plan to take amiodarone and upgrade with dual-chamber implantable cardioverter-defibrillator or CRT-D at an appropriate time.During the follow-up at 3 mo after LBBP,the patient showed an improvement in cardiac function with slight improvement in echocardiography parameters,and the New York Heart Association functional class was maintained at I.Moreover,the patient no longer suffered from chest tightness and palpitation.Holter showed decreased ventricular arrhythmia of less than 5%.CONCLUSION LBBP might be used in patients with heart failure and a high-degree atrioventricular block as an alternative to conventional CRT.
文摘In recent years, the indications of cardiac pacing have extended continuously with the rapid development of pacing technique. Pacemaker treatment has not only limited in arrhythmias of bradycardia and the number of pacemaker treatment has increased year by year. However, more and more new congestive heart failure （ CHF ） and aggravated CHF have appeared in patients after pacing therapy. Therefore, it is a hot topic that how to select reasonable pacing mode to reduce CHF occurrence or relieve CHF symptoms in patients with CHF.
