Achieving Cardiac resynchronization therapy (CRT) with Biventricular
pacing(BiVP) pacing for patients with moderate-to-severe heart failure
(HF), left ventricular (LV) systolic dysfunction and ventricular
dyssynchrony is well established and is currently the standard of care.
Multiple studies have demonstrated significant improvement in quality of
life, functional status, and exercise capacity in patients with New York
Heart Association (NYHA) class III and IV heart failure who underwent
resynchronization therapy1,2. In addition, resynchronization therapy is
associated with survival benefit3. However, one third of patients do not
respond to BIVP. New modalities for resynchronization have emerged
namely His bundle pacing (HBP) and left ventricular septal pacing
(LVSP). In this paper, we will review the benefits and limitations of
BiVP and also the role of new pacing modalities such as HBP and LVSP in
patients with HF with reduced left ventricular ejection fraction (LVEF)
and electrical dysynchrony.