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Related Experiment Videos

Direct His-bundle pacing: present and future.

Pramod M Deshmukh1, Mary Romanyshyn

  • 1Guthrie Healthcare System, Sayre, Pennsylvania 18840, USA. PSeck@clinic.guthrie.org

Pacing and Clinical Electrophysiology : PACE
|June 11, 2004
PubMed
Summary

Direct His-bundle pacing (DHBP) is a safe and effective alternative to right ventricular apical pacing in patients with cardiomyopathy. DHBP improves ejection fraction, functional class, and cardiopulmonary reserve.

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Area of Science:

  • Cardiology
  • Electrophysiology
  • Medical Devices

Background:

  • Right ventricular apical pacing (RVA) can lead to dyssynchronous ventricular activation.
  • Direct His-bundle pacing (DHBP) offers potential for more physiological ventricular activation.
  • Patients with cardiomyopathy often require pacing for heart failure management.

Purpose of the Study:

  • To evaluate the safety and efficacy of DHBP as an alternative to RVA pacing.
  • To assess the impact of DHBP on cardiac function and exercise capacity.
  • To compare the Treppe effect and cardiopulmonary reserve between DHBP and RVA pacing.

Main Methods:

  • DHBP was attempted in 54 patients with cardiomyopathy, persistent atrial fibrillation, and normal QRS duration.
  • Ejection fraction (EF), functional class, and dP/dt were assessed.

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  • Cardiopulmonary testing was performed in patients who also received an RVA lead.
  • Long-term follow-up was conducted to evaluate survival and clinical outcomes.

    • Main Results:

    • DHBP was successful in 39 patients, with a mean follow-up of 42 months.
    • Patients showed improved EF (0.23 to 0.33) and functional class (3.5 to 2.2).
    • DHBP demonstrated a superior Treppe effect and enhanced cardiopulmonary reserve compared to RVA pacing, with longer exercise time and higher O2 uptake.

    Conclusions:

    • Long-term DHBP is safe and effective in patients with cardiomyopathy.
    • DHBP provides superior cardiac contractility response and improved exercise capacity compared to RVA pacing.
    • DHBP represents an advantageous pacing strategy for selected patients.