Leventopoulos Georgios, Nastouli Kassiani-Maria, Bozika Maria, Papastavrou Eleni, Apostolos Anastasios, Koros Rafail, Perperis Angelos, Koniari Ioanna, Vlassopoulou Niki, Chronopoulos Panagiotis, Travlos Christoforos K, Moulias Athanasios, Davlouros Periklis
Department of Medicine, Division of Cardiology, University Hospital of Patras, 265 04 Patras, Greece.
First Department of Cardiology, Hippocration General Hospital, National and Kapodistrian University of Athens, 157 72 Athens, Greece.
J Clin Med. 2025 Apr 27;14(9):3025. doi: 10.3390/jcm14093025.
Cardiac resynchronization therapy (CRT) using biventricular (BiV) pacing is the standard treatment for heart failure (HF) patients with reduced left ventricular ejection fraction (LVEF) and electrical dyssynchrony. However, one in three patients remains a non-responder. Left bundle branch area pacing (LBBAP) could represent a more physiological alternative, but its effectiveness is limited in cases of atypical left bundle branch block (LBBB) or intraventricular conduction delay (IVCD). Left Bundle Branch Pacing Optimized cardiac resynchronization therapy (LOT-CRT) integrates LBBAP with coronary sinus (CS) lead pacing to improve electrical synchrony and clinical outcomes. This review evaluates the feasibility, advantages, disadvantages, and clinical outcomes of LOT-CRT. Additionally, we describe our center's experience and propose an evidence-based implantation algorithm. A review of published studies investigating LOT-CRT was conducted, comparing its effectiveness with BiV-CRT and LBBAP alone using QRS narrowing, LVEF improvement, left ventricular remodeling, New York Heart Association (NYHA) class changes and NT-proBNP levels. It was found that LOT-CRT outperforms BiV-CRT or LBBAP alone in selected populations, at the cost of higher clinical skills, longer procedural times, and specific device setups. Randomized trials are underway to further define its role in clinical practice.
使用双心室（BiV）起搏的心脏再同步治疗（CRT）是左心室射血分数（LVEF）降低且存在电不同步的心力衰竭（HF）患者的标准治疗方法。然而，三分之一的患者仍然没有反应。左束支区域起搏（LBBAP）可能是一种更符合生理的替代方法，但在非典型左束支传导阻滞（LBBB）或室内传导延迟（IVCD）的情况下其有效性有限。左束支起搏优化心脏再同步治疗（LOT-CRT）将LBBAP与冠状窦（CS）导联起搏相结合，以改善电同步性和临床结局。本综述评估了LOT-CRT的可行性、优点、缺点和临床结局。此外，我们描述了我们中心的经验并提出了一种基于证据的植入算法。对已发表的研究LOT-CRT的研究进行了综述，使用QRS波变窄、LVEF改善、左心室重塑、纽约心脏协会（NYHA）心功能分级变化和NT-proBNP水平，将其有效性与单独的BiV-CRT和LBBAP进行比较。结果发现，在特定人群中，LOT-CRT的表现优于单独的BiV-CRT或LBBAP，但代价是需要更高的临床技能、更长的手术时间和特定的设备设置。正在进行随机试验以进一步确定其在临床实践中的作用。
