Right ventricular pacing can cause ventricular dyssynchrony and result in reduced left ventricular systolic function and heart failure. Permanent His bundle pacing is a more physiologic form of ...pacing, but can be technically challenging. In this article, we describe our technique for permanent His bundle pacing including special considerations and limitations associated with His bundle pacing.
In this multicenter trial involving patients with paroxysmal atrial fibrillation who had not previously received rhythm-control treatment, cryoballoon ablation resulted in a significantly higher ...percentage of patients with treatment success at 1 year than antiarrhythmic drug therapy, with a low incidence of procedure-related adverse events.
Right ventricular pacing (RVP) is associated with heart failure and increased mortality. His bundle pacing (HBP) is a physiological alternative to RVP.
This study sought to evaluate clinical outcomes ...of HBP compared to RVP.
All patients requiring initial pacemaker implantation between October 1, 2013, and December 31, 2016, were included in the study. Permanent HBP was attempted in consecutive patients at 1 hospital and RVP at a sister hospital. Implant characteristics, all-cause mortality, heart failure hospitalization (HFH), and upgrades to biventricular pacing (BiVP) were tracked. Primary outcome was the combined endpoint of death, HFH, or upgrade to BiVP. Secondary endpoints were mortality and HFH.
HBP was successful in 304 of 332 consecutive patients (92%), whereas 433 patients underwent RVP. The primary endpoint of death, HFH, or upgrade to BiVP was significantly reduced in the HBP group (83 of 332 patients 25%) compared to RVP (137 of 433 patients 32%; hazard ratio HR: 0.71; 95% confidence interval CI: 0.534 to 0.944; p = 0.02). This difference was observed primarily in patients with ventricular pacing >20% (25% in HBP vs. 36% in RVP; HR: 0.65; 95% CI: 0.456 to 0.927; p = 0.02). The incidence of HFH was significantly reduced in HBP (12.4% vs. 17.6%; HR: 0.63; 95% CI: 0.430 to 0.931; p = 0.02). There was a trend toward reduced mortality in HBP (17.2% vs. 21.4%, respectively; p = 0.06).
Permanent HBP was feasible and safe in a large real-world population requiring permanent pacemakers. His bundle pacing was associated with reduction in the combined endpoint of death, HFH, or upgrade to BiVP compared to RVP in patients requiring permanent pacemakers.
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The frequency in which His bundle pacing can correct left bundle branch block patterns in an unselected heart failure population is not known, and no prospective trials comparing BiV-CRT versus His ...bundle pacing in lieu of a left ventricular lead for CRT (His-CRT) have been performed to date. The His-SYNC (His Bundle Pacing versus Coronary Sinus Pacing for Cardiac Resynchronization Therapy) pilot trial was an investigator-initiated, prospective, randomized controlled trial that aimed to assess the feasibility and efficacy of His-CRT as a first-line strategy compared with BiV-CRT. Among 41 patients enrolled (64 ± 13 years of age, 38% women, LVEF 28%, 65% with coronary artery disease, QRS width 168 ± 18 ms left bundle branch block pattern = 35, right bundle branch block = 2, paced = 3), 21 were randomized to His-CRT and 20 to BiV-CRT.
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.
The purpose of this study was to assess the feasibility and outcomes of HBP in CRT eligible or failed patients.
HBP was attempted as a rescue strategy in patients with failed left ventricular lead or nonresponse 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, New York Heart Association functional class, and echocardiographic data were assessed in follow-up.
HBP was successful in 95 of 106 patients (90%): 30 in group I and 65 in group II. Mean age was 71 ± 12 years and 30% were female, with BBB in 45%, paced rhythm in 39%, and AV block in 16%. His capture and BBB correction thresholds were 1.4 ± 0.9 V and 2.0 ± 1.2 V at 1 ms, respectively. During mean follow-up of 14 months, both groups demonstrated significant narrowing of QRS from 157 ± 33 ms to 117 ± 18 ms (P = .0001), increase in left ventricular ejection fraction from 30% ± 10% to 43% ± 13% (P = .0001), and improvement in New York Heart Association functional class from 2.8 ± 0.5 to 1.8 ± 0.6 (P = .0001) with HBP. Lead-related complications occurred in 7 patients.
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.
Right ventricular pacing (RVP) has been associated with heart failure and increased mortality. His-bundle pacing (HBP) is more physiological but requires a mapping catheter or a backup right ...ventricular lead and is technically challenging.
We sought to assess the feasibility, safety, and clinical outcomes of permanent HBP in an unselected population as compared to RVP.
All patients requiring pacemaker implantation routinely underwent attempt at permanent HBP using the Select Secure (model 3830) pacing lead in the year 2011 delivered through a fixed-shaped catheter (C315 HIS) at one hospital and RVP at the second hospital. Patients were followed from implantation, 2 weeks, 2 months, 1 year, and 2 years. Fluoroscopy time (FT), pacing threshold (PTh), complications, heart failure hospitalization, and mortality were compared.
HBP was attempted in 94 consecutive patients, while 98 patients underwent RVP. HBP was successful in 75 patients (80%). FT was similar (12.7 ± 8 minutes vs 10 ± 14 minutes; median 9.1 vs 6.4 minutes; P = .14) and PTh was higher in the HBP group than in the RVP group (1.35 ± 0.9 V vs 0.6 ± 0.5 V at 0.5 ms; P < .001) and remained stable over a 2-year follow-up period. In patients with >40% ventricular pacing (>60% of patients), heart failure hospitalization was significantly reduced in the HBP group than in the RVP group (2% vs 15%; P = .02). There was no difference in mortality between the 2 groups (13% in the HBP group vs 18% in the RVP group; P = .45).
Permanent HBP without a mapping catheter or a backup right ventricular lead was successfully achieved in 80% of patients. PTh was higher and FT was comparable to those of the RVP group. Clinical outcomes were better in the HBP group than in the RVP group.
Right ventricular pacing (RVP) is associated with heart failure and increased mortality. His-bundle pacing (HBP) is a physiological alternative to RVP.
The purpose of this study was to report ...long-term performance and compare the clinical outcomes of permanent HBP vs RVP.
All patients requiring pacemaker implantation underwent an attempt at permanent HBP in 2011 at one hospital and RVP at the sister hospital. Patients were followed from implantation, 2 weeks, 2 months, and yearly for 5 years. Left ventricular ejection fraction (LVEF), pacing thresholds, lead revision, and generator change were tracked. Primary outcome was the combined endpoint of death or heart failure hospitalization (HFH) at 5 years.
HBP was attempted in 94 consecutive patients and was successful in 75 (80%); 98 patients underwent RVP. LVEF remained unchanged in the HBP group (55% ± 8% vs 57% ± 6%; P = .13), whereas significant decline was noted in the RVP group (57% ± 7% vs 52% ± 11%; P = .002). Incidence of pacing-induced cardiomyopathy was significantly lower in HBP compared to RVP patients (2% vs 22%; P = .04). At 5 years, death or HFH was significantly lower in HBP compared to RVP patients with >40% ventricular pacing (32% vs 53%; hazard ratio 1.9; P = .04). At 5 years, the need for lead revisions (6.7% vs 3%) and for generator change (9% vs 1%) were higher in the HBP group.
In patients undergoing pacemaker implantation, permanent HBP was associated with reduction in death or HFH during long-term follow-up compared to RVP. HBP was associated with higher rates of lead revisions and generator change.
Permanent cardiac pacing of the His-bundle restores and retains normal electrical activation of the ventricles. Data on His-bundle pacing (HBP) are largely limited to small single-centre reports, and ...clinical benefits and risks have not been systematically examined. We sought to systematically examine published studies of patients undergoing permanent HBP and quantify the benefits and risks of the therapy.
PubMed, Embase, and Cochrane Library were searched for full-text articles on permanent HBP. Clinical outcomes of interest included implant success rate, procedural and lead complications, pacing thresholds, QRS duration, and ejection fraction at follow-up, and mortality. Data were extracted and summarized. Where possible, meta-analysis of aggregate data was performed. Out of 2876 articles, 26 met the inclusion criteria representing 1438 patients with an implant attempt. Average age of patients was 73 years and 62.1% were implanted due to atrioventricular block. Overall average implant success rate was 84.8% and was higher with use of catheter-delivered systems (92.1%; P < 0.001). Average pacing thresholds were 1.71 V at implant and 1.79 V at >3 months follow-up; although, pulse widths varied at testing. Average left ventricular ejection fractions (LVEFs) were 42.8% at baseline and 49.5% at follow-up. There were 43 complications observed in 907 patients across the 17 studies that reported safety information.
Among 26 articles of permanent HBP, the implant success rate averaged 84.8% and LVEF improved by an average of 5.9% during follow-up. Specific reporting of our clinical outcomes of interest varied widely, highlighting the need for uniform reporting in future HBP trials.
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