Conduction System Pacing The 5th Pillar of HF Therapy.pptx

1、,Conduction System Pacing:The 5th Pillar of Heart Failure,Gaurav A.Upadhyay,MD,FACC,FHRSAssociate Professor of MedicineVice Chief of Cardiology,Promotions&AppointmentsDirector,Pacing&Defibrillation Clinic|Director,Heart StationChicago Hemodynamic ForumChicago,IL 11/14/25,Disclosures:Scientific advis

2、or or speaker for Abbott,Biotronik,Boston Scientific,GE Medical,Medtronic,Philips,Rhythm Science and Zoll Medical,2,Shoot em up Sam!,Helpful Sven,Questions,Why the excitement for conduction system pacing(CSP)?How can CSP be used to treat HFrEF?How can CSP be used to treat HFpEF?,3,4,ID/CC:61-year-ol

3、d woman with history of bradycardia due to 2:1 block,normal TTE,normal cardiac MRI,nonobstructive CAD Undergoes pacemaker placement.,Pacing 40%99%over 4 years.,LV Function Has Deteriorated,5,5,What happened to this patient after continuous RV pacing?Pacing induced cardiomyopathy,Pacing induced cardi

4、omyopathy,Why isnt RV pacing good enough?,6,Myocardial perfusionTse et al.JACC 1997.Nielson et al.JACC 2000.,Myocardial workPrinzen et al.JACC 1999.,Ventricular dyssynchronyPrinzen et al.JACC 1999.Tops et al.JACC 2009.,Myofibrillar disarrayAdmomian et al.Am Heart J 1986.Karpawich et al.PACE 1999.,In

5、tracellular lipid,inflammation and apoptosisLin et al.JAHA 2019,What can we offer this patient?,7,Summary:61F with acute heart failure decompensation in setting of increasing RV pacing,Titrate medical therapyDevice upgrade to CRT-PDevice upgrade to CSP-DDevice upgrade to CSPDo something else,Four Pi

6、llars of Heart Failure,8,FIVE Pillars of Heart Failure,9,Pacing Options in 2025,Bachmann bundle area pacing(BBAP)Biventricular pacing(BiVP)His-bundle(HBP)LBB area pacing(LBBAP)Leadless pacing,10,HOT-CRTLOT-CRT,Too many options!How do we approach device selection for patients?,New Guidelines on CPP!,