Permanent His Bundle Pacing in Patients With Congenital Complete Heart Block: A Multicenter Experience
Gopi Dandamudi1, Joel Simon2, Oscar Cano3
1Division of Cardiology, CHI Franciscan, Tacoma, Washington, USA; Division of Cardiology, Indiana University School of Medicine, Indianapolis, Indiana, USA.
Insights
His bundle pacing (HBP) is safe and effective for congenital complete heart block (CCHB), improving patient outcomes. Further research is needed to confirm these findings in larger congenital complete heart block populations.
Area of Science:
- Cardiology
- Electrophysiology
Background:
- His bundle pacing (HBP) is established in adult pacing.
- The efficacy and safety of HBP in congenital complete heart block (CCHB) remain under investigation.
Purpose of the Study:
- To assess the safety and efficacy of permanent His bundle pacing (HBP) in patients with congenital complete heart block (CCHB).
Main Methods:
- Retrospective analysis of 17 patients with CCHB who underwent HBP across 6 centers (2016-2019).
- Evaluated device parameters, NYHA functional class, QRS duration, and LVEF.
- Compared outcomes in de novo implants versus patients with prior right ventricular (RV) leads.
Main Results:
- Significant improvement in NYHA functional class (1.7 to 1.1, p=0.014) and decrease in impedance (p<0.001).
- HBP significantly reduced QRS duration in patients with prior RV pacing (167.1ms to 118.3ms, p<0.0001).
- Two patients required lead revision due to elevated pacing thresholds.
Conclusions:
- His bundle pacing (HBP) appears safe and effective for congenital complete heart block (CCHB) patients.
- HBP demonstrated improvements in clinical outcomes.
- Larger studies with extended follow-up are necessary to validate these results.
Objectives:
This study retrospectively assessed the safety and efficacy of permanent His bundle pacing (HBP) in patients with congenital complete heart block (CCHB).
Background:
HBP has become an accepted form of pacing in adults. Its role in CCHB is not known.
Methods:
Seventeen patients with CCHB who underwent successful HBP were analyzed at 6 academic centers between 2016 and 2019. Nine patients had de novo implants, and 8 patients had previous right ventricular (RV) leads. Three RV paced patients had reduced left ventricular ejection fractions at the time of HBP. Implant/follow-up device parameters, New York Heart Association functional class, QRS duration, and left ventricular ejection fraction data were analyzed.
Results:
Patients' mean age was 27.4 ± 11.3 years, 59% were women, and mean follow-up was 385 ± 279 days. The following parameters were found to be statistically significant between implant and follow-up, respectively: impedance, 602 ± 173 Ω versus 460 ± 80 Ω (p < 0.001); and New York Heart Association functional class, 1.7 ± 0.9 versus 1.1 ± 0.3 (p = 0.014). In patients with previous RV pacing, HBP resulted in a significant decrease in QRS duration: 167.1 ± 14.3 ms versus 118.3 ± 13.9 ms (p < 0.0001). In de novo implants, HBP resulted in increases in QRS duration compared with baseline: 111.1 ± 19.4 ms versus 91.0 ± 4.8 ms (p = 0.016). Other parameters exhibited no statistically significant differences. During follow-up, 2 patients required lead revision due to elevated pacing thresholds.
Conclusions:
HBP seems to be safe and effective, with improvement in clinical outcomes in patients with CCHB. Larger studies with longer follow-up periods are required to confirm our findings.
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