2023 <scp>HRS</scp>/<scp>APHRS</scp>/<scp>LAHRS</scp> guideline on cardiac physiologic pacing for the avoidance and mitigation of heart failure

Chung, Mina K.; Patton, Kristen K.; Lau, Chu‐Pak; Birgersdotter‐Green, Ulrika; Curtis, Anne B.; Cygankiewicz, Iwona; Dandamudi, Gopi; Glotzer, Taya V.; Gold, Michael R.; Goldberger, Zachary D.; Guzmán, Juan C.; Huang, Weijian; Imrey, Peter B.; Indik, Julia H.; Khaykin, Yaariv; Parkash, Ratika; Pathak, Rajeev K.; Seow, Swee‐Chong; Shen, Win‐Kuang; Sridhar, Arun Raghav Mahankali; Tapias, Carlos Andres; Varma, Niraj; Vijayaraman, Pugazhendhi; Zeitler, Emily P.

doi:10.1002/joa3.12872

Cited by 11 publications

(3 citation statements)

References 509 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Current European and US guidelines define QRSd cut-offs of 130ms and 120ms respectively, as the target criteria for CRT implantation. (1,31,32) These cut-offs are defined from meta-analyses of studies with few female participants, which may hide a possible beneficial effect of CRT in female patients with narrower QRSd. (33) This study opens the debate on whether the use of normalized QRSd should be integrated into routine clinical practice to identify these patients.…”

Section: Discussionmentioning

confidence: 99%

Heart size disparity drives sex-specific response to cardiac resynchronization therapy: a post-hoc analysis of the MORE-MPP CRT trial

Wijesuriya,

Mehta,

De Vere

et al. 2023

Preprint

View full text Add to dashboard Cite

BackgroundStudies have reported that female sex predicts superior cardiac resynchronization therapy (CRT) response. One theory is that this association is related to smaller female heart size, thus increased “relative dyssynchrony” at given QRS durations (QRSd).ObjectiveTo investigate the mechanisms of sex-specific CRT response relating to heart size, relative dyssynchrony, cardiomyopathy type, QRS morphology, and other patient characteristics.MethodsA post-hoc analysis of the MORE-CRT MPP trial (n=3739, 28% female), with a sub-group analysis of patients with non-ischaemic cardiomyopathy (NICM) and left bundle branch block (LBBB) (n=1308, 41% female) to control for confounding characteristics. A multivariable analysis examined predictors of response to 6 months of conventional CRT, including sex and relative dyssynchrony, measured by QRSd/LVEDV (left ventricular end-diastolic volume).ResultsFemales had a higher CRT response rate than males (70.1% vs. 56.8%, p<0.0001).Subgroup analysis:Regression analysis of the NICM LBBB subgroup identified QRSd/LVEDV, but not sex, as a modifier of CRT response (p<0.0039). QRSd/LVEDV was significantly higher in females (0.919) versus males (0.708, p<0.001). CRT response was 78% for female patients with QRSd/LVEDV>median value, compared to 68% < median value (p=0.012). Association between CRT response and QRSd/LVEDV was strongest at QRSd<150ms.ConclusionsIn the NICM LBBB population, increased relative dyssynchrony in females, who have smaller heart sizes than their male counterparts, is a driver of sex-specific CRT response, particularly at QRSd <150ms. Females may benefit from CRT at a QRSd <130ms, opening the debate on whether sex-specific QRSd cut-offs or QRS/LVEDV measurement should be incorporated into clinical guidelines.

show abstract

Section: Discussionmentioning

confidence: 99%

Heart size disparity drives sex-specific response to cardiac resynchronization therapy: a post-hoc analysis of the MORE-MPP CRT trial

Wijesuriya,

Mehta,

De Vere

et al. 2023

Preprint

View full text Add to dashboard Cite

show abstract

“…The current Heart Rhythm Society/Asia Pacific Heart Rhythm Society/Latin American Heart Rhythm Society guidelines on pacing gives LBBP-CRT a class 2a recommendation for preventing heart failure in patients in whom BiVP-CRT cannot be achieved. Further, a 2b recommendation was given for LBBP-CRT as an alternative to BiVP-CRT for interventionists with adequate experience with CSP[ 21 ].…”

Section: Lbbp-crt Vs Bivp-crtmentioning

confidence: 99%

Left bundle branch pacing set to outshine biventricular pacing for cardiac resynchronization therapy?

Batta,

Hatwal

2024

World J Cardiol

View full text Add to dashboard Cite

The deleterious effects of long-term right ventricular pacing necessitated the search for alternative pacing sites which could prevent or alleviate pacing-induced cardiomyopathy. Until recently, biventricular pacing (BiVP) was the only modality which could mitigate or prevent pacing induced dysfunction. Further, BiVP could resynchronize the baseline electromechanical dssynchrony in heart failure and improve outcomes. However, the high non-response rate of around 20%-30% remains a major limitation. This non-response has been largely attributable to the direct non-physiological stimulation of the left ventricular myocardium bypassing the conduction system. To overcome this limitation, the concept of conduction system pacing (CSP) came up. Despite initial success of the first CSP via His bundle pacing (HBP), certain drawbacks including lead instability and dislodgements, steep learning curve and rapid battery depletion on many occasions prevented its widespread use for cardiac resynchronization therapy (CRT). Subsequently, CSP via left bundle branch-area pacing (LBBP) was developed in 2018, which over the last few years has shown efficacy comparable to BiVP-CRT in small observational studies. Further, its safety has also been well established and is largely free of the pitfalls of the HBP-CRT. In the recent metanalysis by Yasmin et al , comprising of 6 studies with 389 participants, LBBP-CRT was superior to BiVP-CRT in terms of QRS duration, left ventricular ejection fraction, cardiac chamber dimensions, lead thresholds, and functional status amongst heart failure patients with left bundle branch block. However, there are important limitations of the study including the small overall numbers, inclusion of only a single small randomized controlled trial (RCT) and a small follow-up duration. Further, the entire study population analyzed was from China which makes generalizability a concern. Despite the concerns, the meta-analysis adds to the growing body of evidence demonstrating the efficacy of LBBP-CRT. At this stage, one must acknowledge that the fact that still our opinions on this technique are largely based on observational data and there is a dire need for larger RCTs to ascertain the position of LBBP-CRT in management of heart failure patients with left bundle branch block.

show abstract

“… 4 A less robust class 2b endorsement is sanctioned for LBBaP even when less than substantial ventricular pacing is anticipated. 5 Therefore, the risks versus benefits of CSP vis‐à‐vis RV endocardial pacing warrants thorough deliberation when balancing any future anticipation of ventricular pacing. The authors hope that any such limited reports will generate focused research yielding a more data‐driven approach to CSP for isolated sinus node dysfunction.…”

mentioning

confidence: 99%

A case of exaggerated exuberance: Iatrogenic atrioventricular block/intra‐Hisian Wenckebach during conduction system pacing

Ghosh,

Sekar,

Sriram

et al. 2023

Journal of Arrhythmia

View full text Add to dashboard Cite

Isolated sinus node dysfunction with its pursuant long‐term risk for atrioventricular (AV) conduction disease poses a unique dilemma for proponents of CSP due to paucity of imprimatur guidelines. In such scenarios, the risk and prognosis of iatrogenic AV block is not well elucidated but is a valid concern. We report a case where CSP was complicated by iatrogenic AV block and peculiarly the rare phenomenon of intra‐Hisian Wenckebach.

show abstract

2023 HRS/APHRS/LAHRS guideline on cardiac physiologic pacing for the avoidance and mitigation of heart failure

Cited by 11 publications

References 509 publications

Heart size disparity drives sex-specific response to cardiac resynchronization therapy: a post-hoc analysis of the MORE-MPP CRT trial

Heart size disparity drives sex-specific response to cardiac resynchronization therapy: a post-hoc analysis of the MORE-MPP CRT trial

Left bundle branch pacing set to outshine biventricular pacing for cardiac resynchronization therapy?

A case of exaggerated exuberance: Iatrogenic atrioventricular block/intra‐Hisian Wenckebach during conduction system pacing

Contact Info

Product

Resources

About