Introduction and purpose
Permanent His bundle pacing (p-HBP) can correct intraventricular conduction disorders and could be a physiological alternative for traditional cardiac resynchronization therapy (CRT) via the coronary sinus: our aim was to describe our results in patients with heart failure and ventricular dysfunction who were resynchronized by p-HBP.
Methods
Prospective descriptive study of patients with CRT indication and who were resynchronized by p-HBP, using the specific tools. The correction of bundle branch block (BBB) by His bundle pacing (HBP) has been previously checked. We analyzed: the global success of the implant, the His thresholds, and the improvement in left ventricular ejection fraction (LVEF) at one month of follow-up.
Results
We included 54 patients (median age 66 (56-72)) with an indication for CRT: 89% (n = 48) with heart failure (HF), left bundle block branch (LBBB) and LVEF <35%; 3% (n = 2) with HF, right bundle block branch (RBBB) and LVEF <35%; 2% (n = 1) with permanent pacemaker, ventricular dysfunction and ventricular pacing >40%; and 6 % (n = 3) with complete AV block, LBBB and ventricular dysfunction. With HBP we corrected the BBB in 83% of patients (n = 45), and we achieved cardiac resynchronization through p-HBP in 93% of this patients (n = 42), with a global success (including those in whom HBP did not correct the BBB) of 78% (n = 42).
The basal QRS was 160 ms (151-162) and the paced QRS was 132 ms (125-145). The median of His acute threshold was 1.6 volts (0.9-1.9), stable at one month of follow-up, excluding one patient whose His threshold progressively increased to 5.5 volts. There was no dislocation of leads in the follow-up. LVEF improved in all patients: basal 30% (27-35) and at one month follow-up 52% (48-64). Median fluoroscopy times of device implantation including the time taken for temporary HBP were 8.1 minutes (range 6.1-9.9). There were no relevant complications during the implant or follow-up; all patients showed clinical subjective improvement.
Conclusions
CRT by p-HBP is feasible and safe in a high percentage of patients, with reasonable times of fluoroscopy, acceptable capture thresholds, and an early improvement in LVEF in patients with HF and an indication for CRT.
Artículo originAl resumen introducción: La llegada de los anticoagulantes directos (ACD) ha supuesto un cambio en el tratamiento de la fibrilación auricular no valvular (FANV) en los últimos años. Los objetivos de este estudio son determinar el grado de control de la anticoagulación con antivitamina K (AVK) y su posible implicación en efectos cardiovasculares adversos mayores (ECAM) y evaluar las diferencias entre el grupo en tratamiento con AVK respecto del grupo con ACD. Pacientes y métodos: Estudio de cohorte prospectivo que incluyó a pacientes consecutivos diagnosticados con FANV valorados en el Servicio de Cardiología con un seguimiento de 18 meses. Se analizaron diferencias demográficas, clínicas y analíticas entre grupos, incluido el grado de control de la anticoagulación del grupo AVK y su posible relación con ECAM. resultados: Se incluyó a 273 pacientes: 46.5% tratados con AVK, 42.5% con ACD y 11% sin tratamiento anticoagulante. El control de la anticoagulación con AVK fue del 62.1%, sin diferencias en ECAM en función de control. El grupo ACD presentó menos ECAM que el grupo de AVK (13.4 vs. 4.3%; HR, 0.90;; p = 0.01), con una menor mortalidad cardiovascular (0.0 vs. 5.5%; HR, 0.94; 0.90-0.98; p = 0.01) y total (0.9 vs. 12.6%; HR, 0.88; p < 0,01), aunque sin diferencias significativas en eventos hemorrágicos (0.9 vs. 4.7%; p = 0.07) ni isquémicos (2.6 vs. 0.8%; p = 0.27). Discusión: Los pacientes con AVK poseen un perfil clínico diferente en comparación con los que reciben ACD. El control de anticoagulación del grupo de AVK fue inadecuado en casi la mitad de los casos. El grupo de AVK presentó más ECAM que el grupo de ACD.
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