{"id":5964,"date":"2025-09-01T13:41:23","date_gmt":"2025-09-01T11:41:23","guid":{"rendered":"https:\/\/rythmologie.fr\/index\/?p=5964"},"modified":"2025-09-05T10:30:39","modified_gmt":"2025-09-05T08:30:39","slug":"comparaison-de-la-stimulation-du-systeme-de-conduction-vs-stimulation-biventriculaire","status":"publish","type":"post","link":"https:\/\/rythmologie.fr\/index\/comparaison-de-la-stimulation-du-systeme-de-conduction-vs-stimulation-biventriculaire\/","title":{"rendered":" Comparaison de la stimulation du syst\u00e8me de ..."},"content":{"rendered":"<h1><strong>Comparaison de la stimulation du syst\u00e8me de conduction vs stimulation biventriculaire<\/strong><\/h1>\n<p><em>PhysiosSync-HF pr\u00e9sent\u00e9 par Dr Zimmerman<\/em><\/p>\n<p><strong>Messages cl\u00e9s <\/strong><\/p>\n<ul>\n<li>\u00c9tude br\u00e9silienne multicentrique randomis\u00e9e de patient indiqu\u00e9 pour resynchronisation<\/li>\n<li>La stimulation physiologique apparait moins efficace que la stimulation biventriculaire sur les crit\u00e8res d\u00e9c\u00e8s, insuffisance cardiaque et remodelage ventriculaire que la stimulation biventriculaire<\/li>\n<li>Population 2\/3 cardiomyopathie dilat\u00e9e et 13% seulement de cardiopathie isch\u00e9mique<\/li>\n<\/ul>\n<p><strong>Introduction<\/strong><\/p>\n<ul>\n<li>La stimulation biventriculaire (BivP) a d\u00e9montr\u00e9 son b\u00e9n\u00e9fice sur la mortalit\u00e9 et l\u2019insuffisance cardiaque<\/li>\n<li>La stimulation des voies de conduction (CSP) et en particulier la stimulation de l\u2019aire de la branche gauche (LBBAP) a \u00e9merg\u00e9 comme une nouvelle strat\u00e9gie de resynchronisation<\/li>\n<li>Des \u00e9tudes ont montr\u00e9 le b\u00e9n\u00e9fice de LBBAP mais il s\u2019agit d\u2019\u00e9tudes r\u00e9trospectives ou randomis\u00e9es de faible effectif avec cross over et faible suivi<\/li>\n<\/ul>\n<p><strong>M\u00e9thodologie et r\u00e9sultats<\/strong><\/p>\n<ul>\n<li><strong>Population :<\/strong> 173 pts randomis\u00e9s \u00e2ge moyen 62 ans 50% femme 2\/3 cardiomyopathie dilat\u00e9e FE 26% QRS 180 ms BBG typique 97%<\/li>\n<li><strong>Design :<\/strong> \u00e9tude randomis\u00e9e multicentrique br\u00e9silienne avec un comit\u00e9 adjudication ind\u00e9pendant. \u00c9tude de la non inf\u00e9riorit\u00e9 CSP vs bivP en intention de traiter sur des patients indiqu\u00e9s classe 1 pour la resynchronisation (NYHA 2-3 FE &gt; 35% QRS&gt;130ms)<\/li>\n<li><strong>Crit\u00e8res primaires<\/strong> DC, hospitalisation HF, Cs urgente HF, modification FEVG M 12<\/li>\n<li><strong>R\u00e9sultat :<\/strong> Proc\u00e9dures LBBAP 66%, stimulation hisienne 2%, septal profond 18% LOT CRT 8%, 8-9% crossover 2 groupes<\/li>\n<li>Bons crit\u00e8res \u00e9lectriques dans les 2 groupes<\/li>\n<li>La stimulation CSP fait mieux sur les crit\u00e8res d\u00e9c\u00e8s, insuffisance cardiaque et remodelage ventriculaire. Le cout de proc\u00e9dure est en revanche inferieur dans le groupe CSP (15 000 dollars) vs bivP (22 000 dollars)<\/li>\n<li>Il faut noter 3 morts subites 1 dans chaque groupe et 1 dans le groupe CSP apr\u00e8s cross over en CRTP. Les patients n\u2019avaient pas de d\u00e9fibrillateur en raison des contraintes du syst\u00e8me de sant\u00e9 br\u00e9silien.<\/li>\n<\/ul>\n<p><strong>Conclusion<\/strong><\/p>\n<p>La stimulation de l\u2019aire de la branche gauche est inf\u00e9rieure \u00e0 la stimulation biventriculaire sur les crit\u00e8res de mortalit\u00e9, insuffisance cardiaque, remodelage ventriculaire sur une population pr\u00e9sentant en majorit\u00e9 une cardiopathie dilat\u00e9e s\u00e9v\u00e8re non isch\u00e9mique.<br \/>\nCette \u00e9tude temporise les r\u00e9sultats d\u2019\u00e9tudes r\u00e9centes et confirme l\u2019int\u00e9r\u00eat de large \u00e9tudes randomis\u00e9es.<\/p>\n<p style=\"text-align: right;\"><em>Auteur : Dr J\u00e9r\u00f4me Taieb, Aix-en-Provence<\/em><\/p>\n<p><strong>Visuels cl\u00e9s<\/strong><\/p>\n<p style=\"text-align: center;\"><strong><a href=\"https:\/\/rythmologie.fr\/index\/wp-content\/uploads\/2025\/09\/systeme-de-conduction-vs-stimulation-biventriculaire-1.svg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignleft wp-image-5965 size-full\" src=\"https:\/\/rythmologie.fr\/index\/wp-content\/uploads\/2025\/09\/systeme-de-conduction-vs-stimulation-biventriculaire-1.svg\" alt=\"\" width=\"907\" height=\"506\" \/><\/a><\/strong><\/p>\n<p>&nbsp;<\/p>\n<p style=\"text-align: left;\"><strong><a href=\"https:\/\/rythmologie.fr\/index\/wp-content\/uploads\/2025\/09\/systeme-de-conduction-vs-stimulation-biventriculaire-2.svg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignleft wp-image-5966 size-full\" src=\"https:\/\/rythmologie.fr\/index\/wp-content\/uploads\/2025\/09\/systeme-de-conduction-vs-stimulation-biventriculaire-2.svg\" alt=\"\" width=\"907\" height=\"457\" \/><\/a><\/strong><\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p style=\"text-align: left;\"><strong>R\u00e9f\u00e9rences bibliographiques<\/strong><\/p>\n<p>Zimerman A, Dal Forno A, Rohde LE, Ternes CM, Alves FD, Decker SR, Silveira AD, Damiani LP, Martinelli Filho M, Costa R, Fagundes AA, Barbosa RM, Gadelha EB, Lima CE, Silva MA, Maldonado JA, de Oliveira JC, Mallmann F, Baggio JM Jr, Duarte CE, Zimerman LI, D&#8217;\u00c1vila A, Polanczyk CA. Conduction system pacing vs biventricular resynchronization in heart failure with reduced ejection fraction and left bundle branch block: Rationale and design of the PhysioSync-HF Trial. Am Heart J. 2025 Dec;290:38-45.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Comparaison de la stimulation du syst\u00e8me de conduction vs stimulation biventriculaire PhysiosSync-HF pr\u00e9sent\u00e9 par Dr Zimmerman Messages cl\u00e9s \u00c9tude br\u00e9silienne multicentrique randomis\u00e9e de patient indiqu\u00e9 pour resynchronisation La stimulation physiologique apparait moins efficace que la stimulation biventriculaire sur les crit\u00e8res d\u00e9c\u00e8s, insuffisance cardiaque et remodelage ventriculaire que la stimulation biventriculaire Population 2\/3 cardiomyopathie dilat\u00e9e et&hellip;<\/p>\n","protected":false},"author":2,"featured_media":6012,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"inline_featured_image":false,"footnotes":"","_links_to":"","_links_to_target":""},"categories":[51,61,22],"tags":[],"class_list":["post-5964","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-congres","category-esc-2025","category-articles","category-51","category-61","category-22","description-off"],"_links":{"self":[{"href":"https:\/\/rythmologie.fr\/index\/wp-json\/wp\/v2\/posts\/5964","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/rythmologie.fr\/index\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/rythmologie.fr\/index\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/rythmologie.fr\/index\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/rythmologie.fr\/index\/wp-json\/wp\/v2\/comments?post=5964"}],"version-history":[{"count":6,"href":"https:\/\/rythmologie.fr\/index\/wp-json\/wp\/v2\/posts\/5964\/revisions"}],"predecessor-version":[{"id":6015,"href":"https:\/\/rythmologie.fr\/index\/wp-json\/wp\/v2\/posts\/5964\/revisions\/6015"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/rythmologie.fr\/index\/wp-json\/wp\/v2\/media\/6012"}],"wp:attachment":[{"href":"https:\/\/rythmologie.fr\/index\/wp-json\/wp\/v2\/media?parent=5964"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/rythmologie.fr\/index\/wp-json\/wp\/v2\/categories?post=5964"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/rythmologie.fr\/index\/wp-json\/wp\/v2\/tags?post=5964"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}