Recorded live on January 18th, 2024
In this recorded Cardiology Grand Rounds presentation, Duke University Professor of Medicine Dr. Sana Al-Khatib covers the evidence and guidelines supporting the use of biventricular pacing, the potential benefits, and limitations of conduction system pacing and the ongoing research efforts to compare the two approaches through randomized clinical trials. Dr. Al-Khatib discusses pacing-induced cardiomyopathy and the importance of minimizing right ventricular (RV) pacing burden to prevent it, data from multiple clinical trials (COMPANION, CARE-HF, MADIT-CRT, RAFT) supporting the benefits of biventricular pacing in improving survival, quality of life, and reducing heart failure hospitalizations in patients with reduced ejection fraction and wide QRS complex. She then covers the potential advantages of conduction system pacing (particularly left bundle branch area pacing) in achieving more physiologic ventricular activation and narrower QRS complexes. Dr. Khatib then delves into observational studies suggesting potential superiority of left bundle branch area pacing over biventricular pacing in improving outcomes and reducing arrhythmias. Dr. Al-Khatib concludes her lecture by encouraging shared decision-making with patients and consideration of individual factors in selecting the appropriate pacing modality.
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Learning Objectives:
1. Discuss indications for biventricular pacing versus conduction system pacing
2. Identify the differences between biventricular pacing and conduction system pacing
3. Evaluate the remaining gaps in knowledge related to these pacing modalities
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