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Updated: Jan 30, 2026

Benefits of Cardiac Resynchronization Therapy in an Asynchronous Heart Failure Model Induced by Left Bundle Branch Ablation and Rapid Pacing
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His-Optimized Cardiac Resynchronization Therapy to Maximize Electrical Resynchronization: A Feasibility Study.

Pugazhendhi Vijayaraman1, Bengt Herweg2, Kenneth A Ellenbogen3

  • 1Division of Cardiac Electrophysiology, Geisinger Heart Institute, Wilkes-Barre, PA (P.V.).

Circulation. Arrhythmia and Electrophysiology
|January 26, 2019
PubMed
Summary
This summary is machine-generated.

His bundle pacing optimized cardiac resynchronization therapy (HOT-CRT) significantly improved electrical synchronization and patient outcomes. This novel approach offers enhanced heart failure management for eligible patients.

Keywords:
bundle branch blockcardiac resynchronization therapycardiomyopathiesdefibrillatorsheart failure

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Area of Science:

  • Cardiology
  • Electrophysiology
  • Heart Failure Management

Background:

  • Cardiac resynchronization therapy (CRT) is a standard treatment for heart failure patients with specific conduction abnormalities.
  • His bundle pacing (HBP) shows potential for improving outcomes by narrowing QRS duration, but optimal pacing strategies are still explored.
  • Current CRT methods may not always achieve maximal electrical resynchronization.

Purpose of the Study:

  • To evaluate the feasibility and efficacy of optimizing CRT by sequential His bundle pacing (HBP) followed by left ventricular (LV) pacing.
  • To introduce and assess the novel His-Optimized CRT (HOT-CRT) approach for maximizing electrical resynchronization in heart failure patients.

Main Methods:

  • A cohort of 27 patients referred for CRT underwent attempted permanent HBP, followed by LV pacing synchronized to the His-ventricular interval.
  • QRS duration was measured at baseline, during HBP, biventricular pacing, and HOT-CRT.
  • Echocardiographic parameters and New York Heart Association functional class were assessed to evaluate treatment response.

Main Results:

  • HOT-CRT was successfully implemented in 25 of 27 patients, achieving significant QRS duration narrowing from 183±27 ms to 120±16 ms.
  • Mean follow-up of 14 months showed significant improvements in LV ejection fraction (24% to 38%) and NYHA functional class (3.3 to 2.04).
  • High response rates were observed: 84% clinical response and 92% echocardiographic response.

Conclusions:

  • HOT-CRT demonstrated improved electrical resynchronization in this feasibility study.
  • The HOT-CRT strategy shows promise for enhancing clinical and echocardiographic outcomes in advanced heart failure patients requiring CRT.