Permanent His Bundle Pacing for Cardiac Resynchronization Therapy in Patients With Heart Failure and Right Bundle Branch Block
- PMID: 30354292
- DOI: 10.1161/CIRCEP.118.006613
Permanent His Bundle Pacing for Cardiac Resynchronization Therapy in Patients With Heart Failure and Right Bundle Branch Block
Abstract
Background Cardiac resynchronization therapy utilizing biventricular pacing is an effective therapy for patients with left ventricular (LV) systolic dysfunction, left bundle branch block, and heart failure. Benefits of biventricular pacing may be limited in patients with right bundle branch block (RBBB). Permanent His bundle pacing (HBP) has recently been reported as an option for cardiac resynchronization therapy. The aim of the study was to assess the feasibility and outcomes of HBP in patients with RBBB and heart failure. Methods HBP was attempted as a primary or rescue (failed LV lead implant) strategy in patients with reduced LV ejection fraction, RBBB, QRS duration ≥120 ms, and New York Heart Association class II to IV heart failure. Implant characteristics, New York Heart Association functional class, and echocardiographic data were assessed in follow-up. Results Mean age was 72±10 years, female 15%, with an average LV ejection fraction of 31±10%. HBP was successful in 37 of 39 patients (95%) with narrowing of RBBB in 78% cases. His capture and bundle branch block correction thresholds were 1.1±0.6 V and 1.4±0.7 V at 1 ms, respectively. During a mean follow-up of 15±23 months, there was a significant narrowing of QRS from 158±24 to 127±17 ms ( P=0.0001), increase in LV ejection fraction from 31±10% to 39±13% ( P=0.004), and improvement in New York Heart Association functional class from 2.8±0.6 to 2±0.7 ( P=0.0001) with HBP. Increase in capture threshold occurred in 3 patients. Conclusions Permanent HBP was associated with significant narrowing of QRS duration and improvement in LV function in patients with RBBB and reduced LV ejection fraction. Permanent HBP is a promising option for cardiac resynchronization therapy in patients with RBBB and reduced LV ejection fraction.
Keywords: atrial fibrillation; cardiac resynchronization therapy; heart failure; patients; right bundle branch block.
Similar articles
-
His-Optimized Cardiac Resynchronization Therapy to Maximize Electrical Resynchronization: A Feasibility Study.Circ Arrhythm Electrophysiol. 2019 Feb;12(2):e006934. doi: 10.1161/CIRCEP.118.006934. Circ Arrhythm Electrophysiol. 2019. PMID: 30681348
-
His-bundle pacing versus biventricular pacing in cardiac resynchronization therapy patients: A crossover design comparison.Heart Rhythm. 2015 Jul;12(7):1548-57. doi: 10.1016/j.hrthm.2015.03.048. Epub 2015 Mar 28. Heart Rhythm. 2015. PMID: 25828601 Clinical Trial.
-
Permanent His-bundle pacing as an alternative to biventricular pacing for cardiac resynchronization therapy: A multicenter experience.Heart Rhythm. 2018 Mar;15(3):413-420. doi: 10.1016/j.hrthm.2017.10.014. Epub 2017 Oct 12. Heart Rhythm. 2018. PMID: 29031929
-
Left bundle branch area pacing in heart failure: A systematic review and meta-analysis with meta-regression.J Cardiovasc Electrophysiol. 2024 Aug;35(8):1536-1547. doi: 10.1111/jce.16304. Epub 2024 May 29. J Cardiovasc Electrophysiol. 2024. PMID: 38812213
-
His-Bundle Pacing and LV Endocardial Pacing as Alternatives to Traditional Cardiac Resynchronization Therapy.Curr Cardiol Rep. 2018 Sep 26;20(11):109. doi: 10.1007/s11886-018-1046-z. Curr Cardiol Rep. 2018. PMID: 30259196 Review.
Cited by
-
Conduction system pacing for cardiac resynchronization therapy: State of the art, current controversies, and future perspectives.Front Physiol. 2023 Jan 13;14:1124195. doi: 10.3389/fphys.2023.1124195. eCollection 2023. Front Physiol. 2023. PMID: 36711020 Free PMC article. Review.
-
Physiologic Pacing Targeting the His Bundle and Left Bundle Branch: a Review of the Literature.Curr Cardiol Rep. 2022 Aug;24(8):959-978. doi: 10.1007/s11886-022-01723-3. Epub 2022 Jun 9. Curr Cardiol Rep. 2022. PMID: 35678938 Review.
-
Decoding left bundle branch block: insights into the future of his-purkinje conduction system pacing.J Thorac Dis. 2019 May;11(5):1742-1745. doi: 10.21037/jtd.2019.05.14. J Thorac Dis. 2019. PMID: 31285863 Free PMC article. No abstract available.
-
Permanent His Bundle Pacing: A programming and troubleshooting guide.Indian Pacing Electrophysiol J. 2020 May-Jun;20(3):121-128. doi: 10.1016/j.ipej.2020.04.004. Epub 2020 Apr 30. Indian Pacing Electrophysiol J. 2020. PMID: 32360610 Free PMC article.
-
Feasibility of Conduction System Pacing in Patients with Baseline Bundle Branch Block-A Single-Center Mid-Term Follow-Up Study.J Clin Med. 2024 Jan 14;13(2):454. doi: 10.3390/jcm13020454. J Clin Med. 2024. PMID: 38256588 Free PMC article.
Publication types
MeSH terms
Grants and funding
LinkOut - more resources
Full Text Sources
Other Literature Sources
Medical
Miscellaneous