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Benefits of Cardiac Resynchronization Therapy in an Asynchronous Heart Failure Model Induced by Left Bundle Branch Ablation and Rapid Pacing
12:45

Benefits of Cardiac Resynchronization Therapy in an Asynchronous Heart Failure Model Induced by Left Bundle Branch Ablation and Rapid Pacing

Published on: December 11, 2017

Permanent His-bundle pacing as an alternative to biventricular pacing for cardiac resynchronization therapy: A

Parikshit S Sharma1, Gopi Dandamudi2, Bengt Herweg3

  • 1Division of Cardiology, Rush University Medical Center, Chicago, Illinois.

Heart Rhythm
|October 17, 2017
PubMed

Insights

Permanent His-bundle pacing (HBP) is a viable alternative for cardiac resynchronization therapy (CRT). This study shows HBP is effective as both a primary strategy and a rescue therapy for patients who did not respond to biventricular pacing (BVP).

Area of Science:

  • Cardiology
  • Electrophysiology
  • Medical Devices

Background:

  • Cardiac resynchronization therapy (CRT) using biventricular pacing (BVP) is established for heart failure, bundle branch block (BBB), and right ventricular pacing.
  • Permanent His-bundle pacing (HBP) presents a novel alternative for CRT.

Purpose of the Study:

  • To evaluate the feasibility and clinical outcomes of His-bundle pacing (HBP) in patients eligible for CRT or those who failed previous CRT.
  • To assess HBP as both a primary and rescue strategy for CRT.

Main Methods:

  • HBP was attempted in 106 patients: as a rescue strategy for failed left ventricular leads or BVP non-responders (Group I), or as a primary strategy for AV block, BBB, or high ventricular pacing burden (Group II).
  • Implant characteristics, NYHA functional class, and echocardiographic data were assessed post-procedure.

Main Results:

  • HBP was successful in 90% (95/106) of patients.
  • Significant improvements were observed in QRS duration (157 to 117 ms), left ventricular ejection fraction (30% to 43%), and NYHA functional class (2.8 to 1.8) (all P < .0001).
  • Lead-related complications occurred in 7 patients.

Conclusions:

  • Permanent His-bundle pacing (HBP) is a promising alternative for CRT.
  • HBP can be considered a rescue strategy for failed biventricular pacing (BVP) and a reasonable primary alternative to BVP for CRT.
Abstract

Keywords:
Biventricular pacingBundle branch blockCardiac resynchronization therapyHis-bundle pacingPermanent pacemaker

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