His bundle pacing delivered better ventricular resynchronization (QRS reduction -18.6 ms; P=0.007) and greater acute hemodynamic response (4.6 mm Hg; P=0.04) than biventricular pacing.
Does His bundle pacing improve ventricular resynchronization and acute hemodynamic function compared to biventricular pacing in patients with heart failure and left bundle branch block?
23 patients with heart failure and left bundle branch block referred for conventional biventricular CRT
His bundle pacing
Conventional biventricular pacing
Ventricular activation (QRS duration, left ventricular activation time, left ventricular dyssynchrony index) and acute hemodynamic functionsurrogate
His bundle pacing provides better acute ventricular resynchronization and hemodynamic improvement than conventional biventricular pacing in patients with heart failure and LBBB.
BACKGROUND: His bundle pacing is a new method for delivering cardiac resynchronization therapy (CRT). OBJECTIVES: The authors performed a head-to-head, high-precision, acute crossover comparison between His bundle pacing and conventional biventricular CRT, measuring effects on ventricular activation and acute hemodynamic function. METHODS: Patients with heart failure and left bundle branch block referred for conventional biventricular CRT were recruited. Using noninvasive epicardial electrocardiographic imaging, the authors identified patients in whom His bundle pacing shortened left ventricular activation time. In these patients, the authors compared the hemodynamic effects of His bundle pacing against biventricular pacing using a high-multiple repeated alternation protocol to minimize the effect of noise, as well as comparing effects on ventricular activation. RESULTS: In 18 of 23 patients, left ventricular activation time was significantly shortened by His bundle pacing. Seventeen patients had a complete electromechanical dataset. In them, His bundle pacing was more effective at delivering ventricular resynchronization than biventricular pacing: greater reduction in QRS duration (-18.6 ms; 95% confidence interval CI: -31.6 to -5.7 ms; p = 0.007), left ventricular activation time (-26 ms; 95% CI: -41 to -21 ms; p = 0.002), and left ventricular dyssynchrony index (-11.2 ms; 95% CI: -16.8 to -5.6 ms; p < 0.001). His bundle pacing also produced a greater acute hemodynamic response (4.6 mm Hg; 95% CI: 0.2 to 9.1 mm Hg; p = 0.04). The incremental activation time reduction with His bundle pacing over biventricular pacing correlated with the incremental hemodynamic improvement with His bundle pacing over biventricular pacing (R = 0.70; p = 0.04). CONCLUSIONS: His resynchronization delivers better ventricular resynchronization, and greater improvement in hemodynamic parameters, than biventricular pacing.
“There has been tremendous enthusiasm in His bundle pacing. It has been shown to correct QRS duration across bundle block patterns. However, the prior work has focused primarily on His corrective pacing as a bailout strategy for failed biventricular pacing, and in limited feasibility studies as first-line therapy.”
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Ahran Arnold
Matthew Shun‐Shin
Daniel Keene
Journal of the American College of Cardiology
Imperial College London
Virginia Commonwealth University
St Bartholomew's Hospital
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Arnold et al. (Sat,) conducted a other in Heart failure and left bundle branch block (n=23). His bundle pacing vs. Conventional biventricular pacing was evaluated on Reduction in QRS duration (Mean difference -18.6 ms, 95% CI -31.6 to -5.7, p=0.007). His bundle pacing delivered better ventricular resynchronization (QRS reduction -18.6 ms; P=0.007) and greater acute hemodynamic response (4.6 mm Hg; P=0.04) than biventricular pacing.
www.synapsesocial.com/papers/69e795638a4862ceef5c8dc5 — DOI: https://doi.org/10.1016/j.jacc.2018.09.073
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