| Abstract [eng] |
Veronika Gorevska. COMPARISON OF CARDIAC RESYNCHRONIZATION THERAPY WITH ALTERNATIVE VENTRICULAR PACING TECHNIQUES (LITERATURE REVIEW) Aim of Research. To review recent scientific literature on physiological pacing, with a comparative analysis of cardiac resynchronisation therapy and alternative ventricular pacing methods, assessing their efficacy, complications and future clinical potential. Objectives. 1.To compare the efficacy of cardiac resynchronisation therapy and alternative methods in terms of electrophysiological, echocardiographic, functional and clinical outcomes. 2.To compare the complications and technical aspects of cardiac resynchronisation therapy with alternative ventricular pacing methods 3.To evaluate the future perspectives of resynchronisation techniques and potential technological improvements. Methods. A review of recent scientific literature was made using the PubMed (Medline) database, covering English language studies from 2018 to 2025. The selection process followed PRISMA guidelines and PICO data selection method. Only studies meeting these criteria were included. Results. Electromechanical asynchrony in heart failure can significantly impair haemodynamics, leading to reduced organ perfusion and worsening symptoms. Although cardiac resynchronization therapy remains the standard intervention, it proves ineffective in up to one-third of patients. Alternative strategies—such as conduction system pacing or its combination with biventricular stimulation—are increasingly considered when biventricular pacing is ineffective or technically impossible. Conduction system pacing provides better electrocardiographic, echocardiographic, functional, and clinical results than biventricular pacing, along with lower complication rate and higher procedural success rate. His bundle pacing offers the most physiological QRS complex narrowing but is limited by hight pacing thresholds and implantation challenges. Conversely, left bundle branch area pacing more effectively corrects distal conduction blocks, features lower and more stable pacing thresholds, and carries a reduced risk of arrhythmias. The success of each method depends on patient's unique features, emphasizing the importance of a personalized approach. However, current evidence is limited by lack of long-term randomized clinical trials evaluating the effectiveness, safety, and overall clinical impact of these alternative pacing techniques. Further research is necessary to validate their long-term benefits and support broader clinical adoption. Conclusions. 1.Both cardiac resynchronisation therapy and alternative ventricular pacing methods improve electrocardiographic, echocardiographic, functional, and clinical outcomes, but effectiveness varies by individual patient characteristics. Left bundle branch area pacing may offer superior results compared to biventricular pacing, but larger randomised trials are needed to confirm this potential. 2.Despite greater technical demands, alternative ventricular pacing methods have lower complication rates, particularly for lead dislodgement. 3.Left bundle branch area pacing stands out as one of the most promising alternatives to biventricular pacing, and advancing its development should be a key focus of future research. |
