![]() The widespread uptake of CRT has been driven by evidence showing significant benefits in both hospitalisations and mortality for patients with symptomatic dyssynchronous heart failure, that is, those with a LV ejection fraction (EF) of below 35%, and a QRS duration (QRSd) of greater than 130 milliseconds (ms) on a 12 lead electrocardiograph (ECG) ( 2). Conventional CRT involves biventricular (BiV) pacing from transvenous leads in the right ventricle (RV) and a coronary sinus branch to provide epicardial left ventricular (LV) stimulation. Finally, we discuss how future research may be designed to address the vital question of how effective CSP in AF patients is, and the potential hurdles we may face in delivering such studies.Ĭardiac Resynchronisation Therapy (CRT) is a cornerstone in the electrical treatment of heart failure ( 1). We next evaluate the largest clinical body of evidence in this field, related to patients receiving CSP following atrioventricular nodal ablation (AVNA) for AF. In this review, we first examine the mechanistic evidence for the importance of sinus rhythm (SR) in CSP by allowing adjustment of atrioventricular delays (AVD) to achieve the optimal electrical response, and thus, whether the efficacy of CSP may be significantly attenuated compared to conventional BiV pacing in the presence of AF. ![]() Despite increasing popularity and widespread uptake, CSP has rarely been specifically examined in patients with atrial fibrillation (AF), a cohort which forms a significant proportion of the heart failure (HF) population.
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