The usefulness of echo-based hemodynamic parameters in cardiac resynchronization therapy with conduction system...

Area of Science:

• Cardiology
• Electrophysiology
• Heart Failure Management

Background:

• His bundle pacing (HBP) offers physiological activation for cardiac resynchronization therapy (CRT).
• Optimal programming strategies for HBP-based CRT systems to maximize cardiac output remain underexplored.

Purpose of the Study:

• To assess the early post-operative hemodynamic impact of cardiac resynchronization therapy with conduction system pacing (CRT+CSP).
• To identify the most effective pacing configuration for improving cardiac output in patients with heart failure and conduction abnormalities.

Main Methods:

• Study included patients with permanent atrial fibrillation, heart failure, and bundle branch block undergoing CRT with HBP implantation.
• Post-operative optimization focused on achieving maximal cardiac output via complex echocardiographic measurements.
• Consecutive analysis of pacing effects: HBP alone, HBP with left ventricular (LV) pacing, HBP with biventricular (BiV) pacing, and BiV without HBP.

Main Results:

• The study comprised 21 patients (mean age 71.2 years, 71.4% male) with non-ischemic cardiomyopathy, NYHA class III/IV heart failure, and a mean QRS duration of 148.8 ms.
• Left ventricular ejection fraction averaged 27.5%.
• His bundle pacing combined with left ventricular pacing yielded the most significant hemodynamic improvement.

Conclusions:

• His bundle pacing plus LV pacing is the optimal configuration for maximizing cardiac output in CRT.
• This pacing strategy demonstrates superior hemodynamic benefits over biventricular pacing and significantly outperforms right ventricular pacing.