Permanent His Bundle Pacing for Cardiac Resynchronization
William A Huang1, Maereg A Wassie1, Olujimi A Ajijola2,3
1UCLA Cardiac Arrhythmia Center, University of California, Los Angeles, CA, USA.
Insights
His bundle pacing (HBP) offers a safe and effective cardiac resynchronization therapy (CRT) by utilizing the heart's natural conduction system. HBP is recommended for specific patient groups, including those with challenging anatomy or who haven't responded to other therapies.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Devices
Background:
- Cardiac resynchronization therapy (CRT) traditionally uses biventricular (BiV) pacing.
- Some patients are non-responders to BiV pacing or have unfavorable anatomy.
- Right ventricular (RV) pacing can lead to pacing-induced cardiomyopathy.
Purpose of the Study:
- To evaluate His bundle pacing (HBP) as a method for CRT.
- To explore HBP's benefits in specific patient populations.
- To assess HBP's safety, efficacy, and potential to prevent RV pacing-induced cardiomyopathy.
Main Methods:
- His bundle pacing (HBP) implantation for CRT.
- Assessment of patient response and outcomes.
- Comparison with traditional biventricular (BiV) pacing.
Main Results:
- HBP is feasible, beneficial, and safe for CRT.
- HBP is effective in patients with unfavorable CS anatomy or BiV non-response.
- HBP may benefit patients with non-left bundle branch block conduction delay and heart failure.
- HBP is strongly considered for preventing RV pacing-induced cardiomyopathy, especially post-ablation.
- Improved operator experience and lead systems enhance HBP success and safety.
- HBP shows comparable success rates, safety, and battery longevity to traditional RV pacing.
Conclusions:
- His bundle pacing (HBP) is a viable and effective alternative for cardiac resynchronization therapy (CRT).
- HBP offers advantages for specific patient subsets, including non-responders and those at risk of cardiomyopathy.
- The use of HBP for CRT is expected to increase significantly with growing experience and technological advancements.
Abstract:
His bundle pacing (HBP) has been shown to be a feasible, beneficial, and safe way to achieve cardiac resynchronization therapy (CRT) with recruitment of the heart's physiological conduction system. HBP should be considered for those with unfavorable coronary sinus (CS) anatomy, and nonresponders to biventricular (BiV) pacing. HBP CRT may also help patients with the nonleft bundle branch block form of conduction delay and heart failure (HF). HBP CRT should be considered strongly in preventing right ventricular (RV) pacing-induced cardiomyopathy, especially after atrioventricular nodal ablation given the discrete nature of the block and the low likelihood of distal block. With increased operator experience and improved lead delivery systems, HBP success rates and safety have improved and are comparable to traditional RV pacing. Battery longevity is also likely comparable to traditional BiV CRT devices. We anticipate the use of HBP CRT growing significantly.
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