Recent advances in the management of ventricular tachyarrhythmias [version 1; referees: 2 approved]

Ventricular arrhythmias are an important cause of cardiovascular morbidity and mortality, particularly in those with structural heart disease, inherited cardiomyopathies, and channelopathies. The goals of ventricular arrhythmia management include symptom relief, improving quality of life, reducing implantable cardioverter defibrillator shocks, preventing deterioration of left ventricular function, reducing risk of arrhythmic death, and potentially improving overall survival. Guideline-directed medical therapy and implantable cardioverter defibrillator implantation remain the mainstay of therapy to prevent sudden cardiac death in patients with ventricular arrhythmias in the setting of structural heart disease. Recent advances in imaging modalities and commercial availability of genetic testing panels have enhanced our mechanistic understanding of the disease processes and, along with significant progress in catheter-based ablative therapies, have enabled a tailored and more effective management of drug-refractory ventricular arrhythmias. Several gaps in our knowledge remain and require further research. In this article, we review the recent advances in the diagnosis and management of ventricular arrhythmias

Rescue left bundle branch area pacing in coronary venous lead failure or nonresponse to biventricular pacing : results from International LBBAP Collaborative Study Group

BACKGROUND: Cardiac resynchronization therapy (CRT) using biventricular pacing (BVP) is effective in patients with heart failure, left bundle branch block (LBBB) and reduced left ventricular function. Left bundle branch area pacing (LBBAP) has been reported as an alternative option for CRT. OBJECTIVE: The aim of this study was to assess the feasibility and outcomes of LBBAP in patients who failed conventional BVP due to coronary venous lead complications or were non-responders to BVP. METHODS: At 16 international centers, LBBAP was attempted in patients with conventional CRT indication who failed BVP due to either, coronary venous (CV) lead complications, or lack of therapeutic response to BVP. We are reporting heart failure hospitalizations (HFH) and death, echocardiographic outcomes, procedural data, pacing parameters, and lead complications including CV lead failure. RESULTS: LBBAP was successfully performed in 200 patients (CV lead failures-156; non-responders-44): age 68±11years, female-35%, LBBB-55%, RVP-23%, ischemic cardiomyopathy-28%, nonischemic cardiomyopathy-63%, LVEF ≤35% in 80%. Procedure and fluoroscopy duration were 119.5±59.6 and 25.7±18.5 min. LBBAP threshold and R-wave amplitudes were 0.68±[email protected] and 10.4±5mV at implant and remained stable during mean follow-up of 12±10.1 months. LBBAP resulted in significant QRS narrowing from 170±28ms to 139±25ms (p<0.001) with V6 R-wave peak times of 85±17ms. LVEF improved from 29±10% at baseline to 40±12% (p<0.001) during follow-up. The risk for death or HFH was lower in CV lead failure compared to non-responders (HR-0.357;95%CI 0.168-0.756,p=0.007) CONCLUSION: LBBAP is a viable alternative for CRT in patients who failed conventional BVP due to CV lead failure or were non-responders