The usefulness of echo-based hemodynamic parameters in cardiac resynchronization therapy with conduction system
Krzysztof Boczar1, Andrzej Ząbek1,2, Karolina Golińska-Grzybała3
1Department of Electrocardiology, The John Paul II Hospital, Kraków, Poland.
Insights
His bundle pacing combined with left ventricular pacing optimizes cardiac output in cardiac resynchronization therapy. This approach offers superior hemodynamic response compared to biventricular or right ventricular pacing alone.
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.
Background:
His bundle pacing (HBP) has proved to be a valuable alternative enabling the physiological activation of cardiac contraction in cardiac resynchronization therapy (CRT). At present, however, little is known about the optimal method of programming of the His bundle-paced CRT systems in terms of achieving the best cardiac output.
Aim:
The aim of this study was to evaluate the impact of cardiac resynchronization therapy with conduction system pacing (CRT+CSP) on echo-based hemodynamic parameters in the early post-operative measurements.
Methods:
The study enrollment criteria included: permanent atrial fibrillation, heart failure and bundle branch block. All patients underwent implantation of CRT + HBP. During the post-operative phase, we aimed to optimize HOT-CRT settings in order to achieve the greatest cardiac output assessed by complex echocardiographic measurements.
Results:
The study included 21 patients, mean age 71.2 (6.3) years, predominantly men (71.4%) with non-ischemic cardiomyopathy 62%. All patients had heart failure with NYHA functional class III and IV (81%). Mean left ventricular ejection fraction was 27.5 (9.7%). The mean duration of the QRS complex was 148.8 ms. The effects of resynchronization pacing: HBP alone, HBP with left ventricular pacing, HBP with biventricular pacing (BiV) and BiV without HBP were analyzed consecutively. HBP combined with left ventricular pacing demonstrated the best hemodynamic response.
Conclusion:
His bundle pacing coupled with LV pacing proved to be the most advantageous pacing program setting with regard to cardiac output. Moreover, it performed better than biventricular pacing and significantly better than RV pacing.
