4 years ago

Permanent His Bundle Pacing as an Alternative to Biventricular Pacing for Cardiac Resynchronization Therapy: A Multi-Center Experience

Permanent His Bundle Pacing as an Alternative to Biventricular Pacing for Cardiac Resynchronization Therapy: A Multi-Center Experience
Cardiac resynchronization therapy (CRT) using biventricular pacing (BVP) is effective in patients with heart failure, bundle branch block (BBB) or right ventricular pacing. Permanent His bundle pacing (HBP) has been reported as an alternative option for CRT. Objective The aim of the study was to assess the feasibility and outcomes of HBP in CRT eligible or failed patients. Methods HBP was attempted as a rescue strategy in patients with failed LV lead or non-response to BVP (Group I); or as a primary strategy in patients with AV block, BBB, or high ventricular pacing burden as an alternative to BVP (Group II) in patients with indications for CRT. Implant characteristics, NYHA functional class and echocardiographic data were assessed in follow-up. Results HBP was successful in 95 of 106 patients (90%); 30 patients in group I and 65 in group II. Mean age was 71±12 yrs, female 30%, BBB 45%, paced rhythm 39%, AV block 16%. His capture and BBB correction thresholds were 1.4±0.9V and 2.0±1.2V@1ms, respectively. During a mean follow-up of 14 months, both groups demonstrated significant narrowing of QRS from 157±33 ms to 117±18 ms (p=0.0001), increase in LVEF from 30±10% to 43±13% (p=0.0001) and improvement in NYHA class from 2.8±0.5 to 1.8±0.6 (p=0.0001) with HBP. Lead related complications occurred in 7 patients. Conclusions Permanent HBP is a promising alternative for CRT. HBP may be considered as a rescue strategy for failed BVP and may be a reasonable primary alternative to BVP for CRT.

Publisher URL: www.sciencedirect.com/science

DOI: S1547527117312079

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