{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T02:38:10Z","timestamp":1760150290980,"version":"build-2065373602"},"reference-count":13,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2023,11,9]],"date-time":"2023-11-09T00:00:00Z","timestamp":1699488000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCDD"],"abstract":"<jats:p>Introduction: Biventricular pacing has been the gold standard for cardiac resynchronization therapy in patients with left bundle branch block and severely reduced left ventricular ejection fraction for decades. However, in the past few years, this role has been challenged by the promising results of conduction system pacing in these patients, which has proven non-inferior and, at times, superior to biventricular pacing regarding left ventricular function outcomes. One of the most important limitations of both procedures is the long fluoroscopy times. Case description: We present the case of a 60-year-old patient with non-ischemic dilated cardiomyopathy and left bundle branch block in whom conduction system pacing was chosen as the first option for resynchronization therapy. A 3D electro-anatomical mapping system was used to guide the lead to the His bundle region, where correction was observed at high amplitudes, and afterward to the optimal septal penetration site. After reaching the left endocardium, left bundle branch pacing achieved a narrow, paced QRS complex with low fluoroscopy exposure. The three-month follow-up showed a significant improvement in clinical status and left ventricular function. Conclusion: Since conduction system pacing requires a great deal of precision, targeting specific, narrow structures inside the heart, 3D mapping is a valuable tool that increases the chances of success, especially in patients with complex anatomies, such as those with indications for cardiac resynchronization therapy.<\/jats:p>","DOI":"10.3390\/jcdd10110456","type":"journal-article","created":{"date-parts":[[2023,11,10]],"date-time":"2023-11-10T01:17:51Z","timestamp":1699579071000},"page":"456","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Optimal Cardiac Resynchronization Therapy with Conduction System Pacing Guided by Electro-Anatomical Mapping: A Case Report"],"prefix":"10.3390","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0840-1736","authenticated-orcid":false,"given":"Catalin","family":"Pestrea","sequence":"first","affiliation":[{"name":"Interventional Cardiology Unit, Brasov County Clinical Emergency Hospital, 500326 Brasov, Romania"},{"name":"Department of Medical and Surgical Specialties, Faculty of Medicine, \u201cTransilvania\u201d University of Brasov, 500019 Brasov, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roxana","family":"Enache","sequence":"additional","affiliation":[{"name":"Interventional Cardiology Unit, Brasov County Clinical Emergency Hospital, 500326 Brasov, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ecaterina","family":"Cicala","sequence":"additional","affiliation":[{"name":"Interventional Cardiology Unit, Brasov County Clinical Emergency Hospital, 500326 Brasov, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Radu","family":"Vatasescu","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania"},{"name":"Electrophysiology and Cardiac Pacing Lab, Clinical Emergency Hospital, 014461 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,11,9]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"3427","DOI":"10.1093\/eurheartj\/ehab364","article-title":"2021 ESC Guidelines on Cardiac Pacing and Cardiac Resynchronization Therapy","volume":"42","author":"Glikson","year":"2021","journal-title":"Eur. Heart J."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1532","DOI":"10.1111\/pace.14336","article-title":"Is His-optimized superior to conventional cardiac resynchronization therapy in improving heart failure? Results from a propensity-matched study","volume":"44","author":"Senes","year":"2021","journal-title":"Pacing Clin. Electrophysiol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1718","DOI":"10.1111\/jce.15976","article-title":"Clinical Outcomes of Conduction System Pacing versus Biventricular Pacing for Cardiac Resynchronization Therapy: A Systematic Review and Meta-Analysis","volume":"34","author":"Kim","year":"2023","journal-title":"J. Cardiovasc. Electrophysiol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"228","DOI":"10.1016\/j.jacc.2023.05.006","article-title":"Comparison of Left Bundle Branch Area Pacing and Biventricular Pacing in Candidates for Resynchronization Therapy","volume":"82","author":"Vijayaraman","year":"2023","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Pestrea, C., Cicala, E., Ivascu, M., Gherghina, A., Pintilie, I., Or\u021ban, F., and Pop, D. (2022). The Impact of Cardiac Chamber Volumes on Permanent His Bundle Pacing Procedural Outcomes\u2014a Single Center Experience. J. Clin. Med., 11.","DOI":"10.3390\/jcm11237076"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1876","DOI":"10.1161\/CIRCULATIONAHA.118.038648","article-title":"Intracardiac Delineation of Septal Conduction in Left Bundle-Branch Block Patterns","volume":"139","author":"Upadhyay","year":"2019","journal-title":"Circulation"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1208","DOI":"10.1093\/europace\/euad043","article-title":"EHRA Clinical Consensus Statement on Conduction System Pacing Implantation: Endorsed by the Asia Pacific Heart Rhythm Society (APHRS), Canadian Heart Rhythm Society (CHRS), and Latin American Heart Rhythm Society (LAHRS)","volume":"25","author":"Burri","year":"2023","journal-title":"Europace"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"4161","DOI":"10.1093\/eurheartj\/ehac445","article-title":"Left Bundle Branch Area Pacing Outcomes: The Multicentre European MELOS Study","volume":"43","author":"Cano","year":"2022","journal-title":"Eur. Heart J."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"3050","DOI":"10.1111\/jce.14242","article-title":"Left Bundle Branch Pacing Utilizing Three Dimensional Mapping","volume":"30","author":"Vijayaraman","year":"2019","journal-title":"J. Cardiovasc. Electrophysiol."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Marcantoni, L., Centioni, M., Pastore, G., Aneris, F., Baracca, E., and Zanon, F. (2023). Conduction System Pacing in Difficult Cardiac Anatomies: Systematic Approach with the 3D Electroanatomic Mapping Guide. Indian Pacing Electrophysiol. J., in press.","DOI":"10.1016\/j.ipej.2023.08.006"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1068","DOI":"10.1093\/europace\/euac232","article-title":"Electroanatomical Mapping\u2013Guided Left Bundle Branch Area Pacing in Patients with Structural Heart Disease and Advanced Conduction Abnormalities","volume":"25","author":"Richter","year":"2022","journal-title":"Europace"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1219","DOI":"10.1007\/s40520-018-1088-5","article-title":"The influence of age on the psychological profile of patients with cardiac implantable electronic devices: Results from the Italian population in a multicenter study conducted by the European Heart Rhythm Association","volume":"31","author":"Fumagalli","year":"2019","journal-title":"Aging Clin. Exp. Res."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1415","DOI":"10.1093\/europace\/euv005","article-title":"Cardiac resynchronization therapy improves psycho-cognitive performance in patients with heart failure","volume":"17","author":"Duncker","year":"2015","journal-title":"Europace."}],"container-title":["Journal of Cardiovascular Development and Disease"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2308-3425\/10\/11\/456\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T21:20:45Z","timestamp":1760131245000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2308-3425\/10\/11\/456"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,11,9]]},"references-count":13,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2023,11]]}},"alternative-id":["jcdd10110456"],"URL":"https:\/\/doi.org\/10.3390\/jcdd10110456","relation":{},"ISSN":["2308-3425"],"issn-type":[{"type":"electronic","value":"2308-3425"}],"subject":[],"published":{"date-parts":[[2023,11,9]]}}}