Skip to main content
Log in

Novel Pacing Strategies for Heart Failure Management

  • Heart Failure (W Tang, Section Editor)
  • Published:
Current Treatment Options in Cardiovascular Medicine Aims and scope Submit manuscript

Opinion statement

Cardiac resynchronization therapy has emerged as the gold standard for heart failure patients with left ventricular systolic dysfunction and electrical dyssynchrony from an intrinsic intraventricular conduction delay or right ventricular pacing. However, the limits imposed by the coronary sinus venous anatomy restrict the applicability of the technology for many potential recipients. Furthermore, conventional resynchronization, by virtue of utilizing a single site of epicardial origin for left ventricular activation, is non-physiological. Several technologies on the horizon, including multisite pacing, left ventricular endocardial, and leadless devices, and direct His-bundle pacing are aimed at improving the response rate of cardiac resynchronization and extending candidacy to patients ineligible for conventional therapy. In this review, we discuss the limitations of the present technology and the role for these new therapies.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: •• Of major importance

  1. Cazeau S, Ritter P, Bakdach S, Lazarus A, Limousin M, Henao L, et al. Four chamber pacing in dilated cardiomyopathy. Pacing Clin Electrophysiol. 1994;17:1974–9.

    Article  CAS  PubMed  Google Scholar 

  2. Daubert JC, Ritter P, Le Breton H, Gras D, Leclercq C, Lazarus A, et al. Permanent left ventricular pacing with transvenous leads inserted into the coronary veins. Pacing Clin Electrophysiol. 1998;21:239–45.

    Article  CAS  PubMed  Google Scholar 

  3. Madhavan M, Mulpuru SK, McLeod CJ, Cha YM, Friedman PA. Advances and future directions in cardiac pacemakers: part 2 of a 2-part series. J am Coll Cardiol. 2017;69:211–35.

    Article  PubMed  Google Scholar 

  4. Epstein AE, Di Marco JP, Ellenbogen KA, Estes NA 3rd, Freedman RA, Gettes LS, et al. 2012 accf/aha/hrs focused update incorporated into the accf/aha/hrs 2008 guidelines for device-based therapy of cardiac rhythm abnormalities: a report of the american college of cardiology foundation/american heart association task force on practice guidelines and the heart rhythm society. J am Coll Cardiol. 2013;61:e6–75.

    Article  PubMed  Google Scholar 

  5. Cazeau S, Leclercq C, Lavergne T, Walker S, Varma C, Linde C, et al. Effects of multisite biventricular pacing in patients with heart failure and intraventricular conduction delay. N Engl J med. 2001;344:873–80.

    Article  CAS  PubMed  Google Scholar 

  6. Abraham WT, Fisher WG, Smith AL, Delurgio DB, Leon AR, Loh E, et al. Cardiac resynchronization in chronic heart failure. N Engl J med. 2002;346:1845–53.

    Article  PubMed  Google Scholar 

  7. Cleland JG, Freemantle N, Daubert JC, Toff WD, Leisch F, Tavazzi L. Long-term effect of cardiac resynchronisation in patients reporting mild symptoms of heart failure: a report from the care-hf study. Heart. 2008;94:278–83.

    Article  CAS  PubMed  Google Scholar 

  8. Moss AJ, Zareba W, Hall WJ, Klein H, Wilber DJ, Cannom DS, et al. Prophylactic implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction. N Engl J med. 2002;346:877–83.

    Article  PubMed  Google Scholar 

  9. Bardy GH, Lee KL, Mark DB, Poole JE, Packer DL, Boineau R, et al. Amiodarone or an implantable cardioverter-defibrillator for congestive heart failure. N Engl J med. 2005;352:225–37.

    Article  CAS  PubMed  Google Scholar 

  10. Bristow MR, Saxon LA, Boehmer J, Krueger S, Kass DA, De Marco T, et al. Cardiac-resynchronization therapy with or without an implantable defibrillator in advanced chronic heart failure. N Engl J med. 2004;350:2140–50.

    Article  CAS  PubMed  Google Scholar 

  11. Linde C, Abraham WT, Gold MR, St John Sutton M, Ghio S, Daubert C. Randomized trial of cardiac resynchronization in mildly symptomatic heart failure patients and in asymptomatic patients with left ventricular dysfunction and previous heart failure symptoms. J am Coll Cardiol. 2008;52:1834–43.

    Article  PubMed  Google Scholar 

  12. Abraham WT, Young JB, Leon AR, Adler S, Bank AJ, Hall SA, et al. Effects of cardiac resynchronization on disease progression in patients with left ventricular systolic dysfunction, an indication for an implantable cardioverter-defibrillator, and mildly symptomatic chronic heart failure. Circulation. 2004;110:2864–8.

    Article  PubMed  Google Scholar 

  13. Moss AJ, Hall WJ, Cannom DS, Klein H, Brown MW, Daubert JP, et al. Cardiac-resynchronization therapy for the prevention of heart-failure events. N Engl J med. 2009;361:1329–38.

    Article  PubMed  Google Scholar 

  14. Tang AS, Wells GA, Talajic M, Arnold MO, Sheldon R, Connolly S, et al. Cardiac-resynchronization therapy for mild-to-moderate heart failure. N Engl J med. 2010;363:2385–95.

    Article  CAS  PubMed  Google Scholar 

  15. Auricchio A, Fantoni C, Regoli F, Carbucicchio C, Goette A, Geller C, et al. Characterization of left ventricular activation in patients with heart failure and left bundle-branch block. Circulation. 2004;109:1133–9.

    Article  PubMed  Google Scholar 

  16. Sipahi I, Chou JC, Hyden M, Rowland DY, Simon DI, Fang JC. Effect of qrs morphology on clinical event reduction with cardiac resynchronization therapy: meta-analysis of randomized controlled trials. Am Heart J. 2012;163:260–7. e263

    Article  PubMed  PubMed Central  Google Scholar 

  17. Cunnington C, Kwok CS, Satchithananda DK, Patwala A, Khan MA, Zaidi A, et al. Cardiac resynchronisation therapy is not associated with a reduction in mortality or heart failure hospitalisation in patients with non-left bundle branch block qrs morphology: meta-analysis of randomised controlled trials. Heart. 2015;101:1456–62.

    Article  CAS  PubMed  Google Scholar 

  18. Cleland JG, Abraham WT, Linde C, Gold MR, Young JB, Claude Daubert J, et al. An individual patient meta-analysis of five randomized trials assessing the effects of cardiac resynchronization therapy on morbidity and mortality in patients with symptomatic heart failure. Eur Heart J. 2013;34:3547–56.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Sipahi I, Carrigan TP, Rowland DY, Stambler BS, Fang JC. Impact of qrs duration on clinical event reduction with cardiac resynchronization therapy: meta-analysis of randomized controlled trials. Arch Intern med. 2011;171:1454–62.

    Article  PubMed  Google Scholar 

  20. Beshai JF, Grimm RA, Nagueh SF, Baker JH 2nd, Beau SL, Greenberg SM, et al. Cardiac-resynchronization therapy in heart failure with narrow qrs complexes. N Engl J med. 2007;357:2461–71.

    Article  CAS  PubMed  Google Scholar 

  21. Ruschitzka F, Abraham WT, Singh JP, Bax JJ, Borer JS, Brugada J, et al. Cardiac-resynchronization therapy in heart failure with a narrow qrs complex. N Engl J med. 2013;369:1395–405.

    Article  CAS  PubMed  Google Scholar 

  22. Thibault B, Harel F, Ducharme A, White M, Ellenbogen KA, Frasure-Smith N, et al. Cardiac resynchronization therapy in patients with heart failure and a qrs complex <120 milliseconds: the evaluation of resynchronization therapy for heart failure (lesser-earth) trial. Circulation. 2013;127:873–81.

    Article  CAS  PubMed  Google Scholar 

  23. Eschalier R, Ploux S, Pereira B, Clementy N, Da Costa A, Defaye P, et al. Assessment of cardiac resynchronisation therapy in patients with wide qrs and non-specific intraventricular conduction delay: rationale and design of the multicentre randomised nicd-crt study. BMJ Open. 2016;6:e012383.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Crt implant strategy using the longest electrical delay for non-left bundle branch block patients (enhance crt).ClinicalTrials.gov Identifier: NCT01983293.

  25. Tanaka H, Hara H, Adelstein EC, Schwartzman D, Saba S, Gorcsan J 3rd. Comparative mechanical activation mapping of rv pacing to lbbb by 2d and 3d speckle tracking and association with response to resynchronization therapy. JACC Cardiovasc Imaging. 2010;3:461–71.

    Article  PubMed  Google Scholar 

  26. Sweeney MO, Hellkamp AS, Ellenbogen KA, Greenspon AJ, Freedman RA, Lee KL, et al. Adverse effect of ventricular pacing on heart failure and atrial fibrillation among patients with normal baseline qrs duration in a clinical trial of pacemaker therapy for sinus node dysfunction. Circulation. 2003;107:2932–7.

    Article  PubMed  Google Scholar 

  27. Wilkoff BL, Cook JR, Epstein AE, Greene HL, Hallstrom AP, Hsia H, et al. Dual-chamber pacing or ventricular backup pacing in patients with an implantable defibrillator: the dual chamber and vvi implantable defibrillator (david) trial. JAMA. 2002;288:3115–23.

    Article  PubMed  Google Scholar 

  28. Sharma AD, Rizo-Patron C, Hallstrom AP, O'Neill GP, Rothbart S, Martins JB, et al. Percent right ventricular pacing predicts outcomes in the DAVID trial. Heart Rhythm. 2005;2:830–4.

    Article  PubMed  Google Scholar 

  29. Shukla HH, Hellkamp AS, James EA, Flaker GC, Lee KL, Sweeney MO, et al. Heart failure hospitalization is more common in pacemaker patients with sinus node dysfunction and a prolonged paced qrs duration. Heart Rhythm. 2005;2:245–51.

    Article  PubMed  Google Scholar 

  30. Sweeney MO, Shea JB, Fox V, Adler S, Nelson L, Mullen TJ, et al. Randomized pilot study of a new atrial-based minimal ventricular pacing mode in dual-chamber implantable cardioverter-defibrillators. Heart Rhythm. 2004;1:160–7.

    Article  PubMed  Google Scholar 

  31. •• Curtis AB, Worley SJ, Adamson PB, Chung ES, Niazi I, Sherfesee L, et al. Biventricular pacing for atrioventricular block and systolic dysfunction. N Engl J med. 2013;368:1585–93. The BLOCK-HF study was pivotal in establishing CRT as appropriate management for patients with LV dysfunction and a high RV-pacing burden. This work followed an accumulation of evidence incriminating right ventricular pacing as deleterious in heart failure.

    Article  CAS  PubMed  Google Scholar 

  32. Funck RC, Mueller HH, Lunati M, Piorkowski C, De Roy L, Paul V, et al. Characteristics of a large sample of candidates for permanent ventricular pacing included in the biventricular pacing for atrio-ventricular block to prevent cardiac desynchronization study (biopace). Europace. 2014;16:354–62.

    Article  PubMed  Google Scholar 

  33. Rodriguez LM, Timmermans C, Nabar A, Beatty G, Wellens HJ. Variable patterns of septal activation in patients with left bundle branch block and heart failure. J Cardiovasc Electrophysiol. 2003;14:135–41.

    Article  PubMed  Google Scholar 

  34. Fornwalt BK, Sprague WW, BeDell P, Suever JD, Gerritse B, Merlino JD, et al. Agreement is poor among current criteria used to define response to cardiac resynchronization therapy. Circulation. 2010;121:1985–91.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Boidol J, Sredniawa B, Kowalski O, Szulik M, Mazurek M, Sokal A, et al. Many response criteria are poor predictors of outcomes after cardiac resynchronization therapy: validation using data from the randomized trial. Europace. 2013;15:835–44.

    Article  PubMed  Google Scholar 

  36. Birnie DH, Tang AS. The problem of non-response to cardiac resynchronization therapy. Curr Opin Cardiol. 2006;21:20–6.

    Article  PubMed  Google Scholar 

  37. Hayes DL, Boehmer JP, Day JD, Gilliam FR 3rd, Heidenreich PA, Seth M, et al. Cardiac resynchronization therapy and the relationship of percent biventricular pacing to symptoms and survival. Heart Rhythm. 2011;8:1469–75.

    Article  PubMed  Google Scholar 

  38. Wilton SB, Leung AA, Ghali WA, Faris P, Exner DV. Outcomes of cardiac resynchronization therapy in patients with versus those without atrial fibrillation: a systematic review and meta-analysis. Heart Rhythm. 2011;8:1088–94.

    Article  PubMed  Google Scholar 

  39. Kamath GS, Cotiga D, Koneru JN, Arshad A, Pierce W, Aziz EF, et al. The utility of 12-lead holter monitoring in patients with permanent atrial fibrillation for the identification of nonresponders after cardiac resynchronization therapy. J am Coll Cardiol. 2009;53:1050–5.

    Article  PubMed  Google Scholar 

  40. Yin J, Hu H, Wang Y, Xue M, Li X, Cheng W, et al. Effects of atrioventricular nodal ablation on permanent atrial fibrillation patients with cardiac resynchronization therapy: a systematic review and meta-analysis. Clin Cardiol. 2014;37:707–15.

    Article  PubMed  Google Scholar 

  41. Lakkireddy D, Di Biase L, Ryschon K, Biria M, Swarup V, Reddy YM, et al. Radiofrequency ablation of premature ventricular ectopy improves the efficacy of cardiac resynchronization therapy in nonresponders. J am Coll Cardiol. 2012;60:1531–9.

    Article  PubMed  Google Scholar 

  42. Mele D, Agricola E, Galderisi M, Rigo F, Citro R, Dal Monte A, et al. Echocardiographic myocardial scar burden predicts response to cardiac resynchronization therapy in ischemic heart failure. J am Soc Echocardiogr. 2009;22:702–8.

    Article  PubMed  Google Scholar 

  43. Adelstein EC, Saba S. Scar burden by myocardial perfusion imaging predicts echocardiographic response to cardiac resynchronization therapy in ischemic cardiomyopathy. Am Heart J. 2007;153:105–12.

    Article  PubMed  Google Scholar 

  44. Rinaldi CA, Burri H, Thibault B, Curnis A, Rao A, Gras D, et al. A review of multisite pacing to achieve cardiac resynchronization therapy. Europace. 2015;17:7–17.

    Article  PubMed  Google Scholar 

  45. Turagam MK, Afzal MR, Iskander S, Reddy M, Di Biase L, Natale A, et al. A meta-analysis of quadripolar versus bipolar left ventricular leads on post-procedural outcomes. J Atr Fibrillation. 2016;9:1472.

    PubMed  PubMed Central  Google Scholar 

  46. Zanon F, Marcantoni L, Baracca E, Pastore G, Lanza D, Fraccaro C, et al. Optimization of left ventricular pacing site plus multipoint pacing improves remodeling and clinical response to cardiac resynchronization therapy at 1 year. Heart Rhythm. 2016;13:1644–51.

    Article  PubMed  Google Scholar 

  47. Pappone C, Calovic Z, Vicedomini G, Cuko A, McSpadden LC, Ryu K, et al. Improving cardiac resynchronization therapy response with multipoint left ventricular pacing: twelve-month follow-up study. Heart Rhythm. 2015;12:1250–8.

    Article  PubMed  Google Scholar 

  48. Tomassoni G, Baker J, Corbisiero R, Love C, Martin D, Sheppard R, et al.. Safety and efficacy of multipoint pacing in cardiac resynchronization therapy: The multipoint pacing (mpp) ide study. Heart Rhythm Society Scientific Sessions. 2016.

  49. More response on cardiac resynchronization therapy with multipoint pacing (more-crt mpp).ClinicalTrials.gov Identifier: NCT02006069.

  50. Singh JP, Fan D, Heist EK, Alabiad CR, Taub C, Reddy V, et al. Left ventricular lead electrical delay predicts response to cardiac resynchronization therapy. Heart Rhythm. 2006;3:1285–92.

    Article  PubMed  Google Scholar 

  51. Khan FZ, Virdee MS, Palmer CR, Pugh PJ, O'Halloran D, Elsik M, et al. Targeted left ventricular lead placement to guide cardiac resynchronization therapy: the target study: a randomized, controlled trial. J am Coll Cardiol. 2012;59:1509–18.

    Article  PubMed  Google Scholar 

  52. Saba S, Marek J, Schwartzman D, Jain S, Adelstein E, White P, et al. Echocardiography-guided left ventricular lead placement for cardiac resynchronization therapy: results of the speckle tracking assisted resynchronization therapy for electrode region trial. Circ Heart Fail. 2013;6:427–34.

    Article  CAS  PubMed  Google Scholar 

  53. Khan FZ, Virdee MS, Gopalan D, Rudd J, Watson T, Fynn SP, et al. Characterization of the suitability of coronary venous anatomy for targeting left ventricular lead placement in patients undergoing cardiac resynchronization therapy. Europace. 2009;11:1491–5.

    Article  PubMed  Google Scholar 

  54. Mair H, Sachweh J, Meuris B, Nollert G, Schmoeckel M, Schuetz A, et al. Surgical epicardial left ventricular lead versus coronary sinus lead placement in biventricular pacing. Eur J Cardiothorac Surg. 2005;27:235–42.

    Article  PubMed  Google Scholar 

  55. Betts TR, Gamble JH, Khiani R, Bashir Y, Rajappan K. Development of a technique for left ventricular endocardial pacing via puncture of the interventricular septum. Circ Arrhythm Electrophysiol. 2014;7:17–22.

    Article  PubMed  Google Scholar 

  56. van Gelder BM, Houthuizen P, Bracke FA. Transseptal left ventricular endocardial pacing: preliminary experience from a femoral approach with subclavian pull-through. Europace. 2011;13:1454–8.

    Article  PubMed  Google Scholar 

  57. Garrigue S, Jais P, Espil G, Labeque JN, Hocini M, Shah DC, et al. Comparison of chronic biventricular pacing between epicardial and endocardial left ventricular stimulation using doppler tissue imaging in patients with heart failure. Am J Cardiol. 2001;88:858–62.

    Article  CAS  PubMed  Google Scholar 

  58. Morgan JM, Biffi M, Geller L, Leclercq C, Ruffa F, Tung S, et al. Alternate site cardiac resynchronization (alsync): a prospective and multicentre study of left ventricular endocardial pacing for cardiac resynchronization therapy. Eur Heart J. 2016;37:2118–27.

    Article  PubMed  Google Scholar 

  59. Tjong FV, Brouwer TF, Kooiman KM, Smeding L, Koop B, Soltis B, et al. Communicating antitachycardia pacing-enabled leadless pacemaker and subcutaneous implantable defibrillator. J am Coll Cardiol. 2016;67:1865–6.

    Article  PubMed  Google Scholar 

  60. Auricchio A, Delnoy PP, Regoli F, Seifert M, Markou T, Butter C. First-in-man implantation of leadless ultrasound-based cardiac stimulation pacing system: novel endocardial left ventricular resynchronization therapy in heart failure patients. Europace. 2013;15:1191–7.

    Article  PubMed  Google Scholar 

  61. Auricchio A, Delnoy PP, Butter C, Brachmann J, Van Erven L, Spitzer S, et al. Feasibility, safety, and short-term outcome of leadless ultrasound-based endocardial left ventricular resynchronization in heart failure patients: results of the wireless stimulation endocardially for crt (wise-crt) study. Europace. 2014;16:681–8.

    Article  PubMed  Google Scholar 

  62. Reddy V, Neuzil P, Riahi S, Sogaard P, Butter C, Schau T et al. Presentation of leadless lv endocardial stimulation for crt: Final outcomes of the safety and performance of electrodes implanted in the left ventricle (select-lv) study.. Heart Rhythm Society 37th Annual Scientific Sessions. 2015.

  63. Narula OS. Longitudinal dissociation in the his bundle. Bundle branch block due to asynchronous conduction within the his bundle in man. Circulation. 1977;56:996–1006.

    Article  CAS  PubMed  Google Scholar 

  64. Sharma PS, Huizar J, Ellenbogen KA, Tan AY. Recruitment of bundle branches with permanent his bundle pacing in a patient with advanced conduction system disease: what is the mechanism? Heart Rhythm. 2016;13:623–5.

    Article  PubMed  Google Scholar 

  65. •• Lustgarten DL, Calame S, Crespo EM, Calame J, Lobel R, Spector PS. Electrical resynchronization induced by direct his-bundle pacing. Heart Rhythm. 2010;7:15–21. This study established the feasibility of His-bundle pacing for resynchronization for patients referred for CRT.

    Article  PubMed  Google Scholar 

  66. Lustgarten DL, Crespo EM, Arkhipova-Jenkins I, Lobel R, Winget J, Koehler J, et al. His-bundle pacing versus biventricular pacing in cardiac resynchronization therapy patients: a crossover design comparison. Heart Rhythm. 2015;12:1548–57.

    Article  PubMed  Google Scholar 

  67. Martin DO, Lemke B, Birnie D, Krum H, Lee KL, Aonuma K, et al. Investigation of a novel algorithm for synchronized left-ventricular pacing and ambulatory optimization of cardiac resynchronization therapy: results of the adaptive crt trial. Heart Rhythm. 2012;9:1807–14.

    Article  PubMed  Google Scholar 

  68. Ellenbogen KA, Gold MR, Meyer TE, Fernndez Lozano I, Mittal S, Waggoner AD, et al. Primary results from the smartdelay determined av optimization: a comparison to other av delay methods used in cardiac resynchronization therapy (smart-av) trial: a randomized trial comparing empirical, echocardiography-guided, and algorithmic atrioventricular delay programming in cardiac resynchronization therapy. Circulation. 2010;122:2660–8.

    Article  PubMed  Google Scholar 

  69. Birnie D, Lemke B, Aonuma K, Krum H, Lee KL, Gasparini M, et al. Clinical outcomes with synchronized left ventricular pacing: analysis of the adaptive crt trial. Heart Rhythm. 2013;10:1368–74.

    Article  PubMed  Google Scholar 

  70. Adaptresponse clinical trial. 2016:ClinicalTrials.gov Identifier: NCT02205359.

  71. Parthiban N, Esterman A, Mahajan R, Twomey DJ, Pathak RK, Lau DH, et al. Remote monitoring of implantable cardioverter-defibrillators: a systematic review and meta-analysis of clinical outcomes. J am Coll Cardiol. 2015;65:2591–600.

    Article  PubMed  Google Scholar 

  72. Varma N, Piccini JP, Snell J, Fischer A, Dalal N, Mittal S. The relationship between level of adherence to automatic wireless remote monitoring and survival in pacemaker and defibrillator patients. J am Coll Cardiol. 2015;65:2601–10.

    Article  PubMed  Google Scholar 

  73. Saxon LA, Hayes DL, Gilliam FR, Heidenreich PA, Day J, Seth M, et al. Long-term outcome after icd and crt implantation and influence of remote device follow-up: the altitude survival study. Circulation. 2010;122:2359–67.

    Article  PubMed  Google Scholar 

  74. Yu CM, Wang L, Chau E, Chan RH, Kong SL, Tang MO, et al. Intrathoracic impedance monitoring in patients with heart failure: correlation with fluid status and feasibility of early warning preceding hospitalization. Circulation. 2005;112:841–8.

    Article  PubMed  Google Scholar 

  75. Bohm M, Drexler H, Oswald H, Rybak K, Bosch R, Butter C, et al. Fluid status telemedicine alerts for heart failure: a randomized controlled trial. Eur Heart J. 2016;37:3154–63.

    Article  PubMed  Google Scholar 

  76. Haeberlin A, Zurbuchen A, Walpen S, Schaerer J, Niederhauser T, Huber C, et al. The first batteryless, solar-powered cardiac pacemaker. Heart Rhythm. 2015;12:1317–23.

    Article  PubMed  Google Scholar 

  77. Kober L, Thune JJ, Nielsen JC, Haarbo J, Videbaek L, Korup E, et al. Defibrillator implantation in patients with nonischemic systolic heart failure. N Engl J med. 2016;375:1221–30.

    Article  PubMed  Google Scholar 

  78. Di Marco A, Anguera I, Schmitt M, Klem I, Neilan T, White JA, et al. Late gadolinium enhancement and the risk for ventricular arrhythmias or sudden death in dilated cardiomyopathy: systematic review and meta-analysis. JACC Heart Failure. 2016;

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Theofanie Mela MD.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Heart Failure

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Leyton-Mange, J.S., Mela, T. Novel Pacing Strategies for Heart Failure Management. Curr Treat Options Cardio Med 19, 64 (2017). https://doi.org/10.1007/s11936-017-0561-3

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11936-017-0561-3

Keywords

Navigation