Early improvement of left ventricular ejection fraction by cardiac resynchronization through His bundle pacing in patients with heart failure

Abstract

Aims Permanent His bundle pacing (p-HBP) can correct intraventricular conduction disorders and could be an alternative to traditional cardiac resynchronization therapy (CRT) via the coronary sinus. We describe the short-term impact of HBP on left ventricular ejection fraction (LVEF) and improvement of left intraventricular synchrony. Methods and results This prospective descriptive study, performed from January 2018 to February 2019, included patients with left bundle branch block (LBBB) and an CRT indication who were resynchronized by p-HBP. We used the Medtronic C315 His catheter or a combination of the CPS-Direct-Universal introducer, CPS-AIM™-Universal subselector (Abbot), and SelectSecure™ MRI-SureScan™ 3830 lead. Correction of the LBBB by HBP had been previously checked. At 1 month of follow-up, we analysed the quantification of LVEF and measurement of the delay of the septal wall with the posterior wall as a parameter of intraventricular synchrony. We included 48 patients with LBBB and an indication for CRT. With HBP, we corrected the LBBB in 81% of patients (n = 39), and we achieved cardiac resynchronization through permanent HBP in 92% of these patients (n = 36). Left ventricular ejection fraction and intraventricular mechanical resynchronization improved in all patients, which was demonstrated by echocardiography through the improvement of the delay of the septal wall with the posterior wall from 138 ms (range 131–151) to 41 ms (19–63). Conclusion There is early improvement after p-HBP in LVEF and left ventricular electromechanical synchronization in patients with LBBB, heart failure, and an indication for CRT.

Electrocardiographic patterns predictive of left bundle branch block correction with His bundle pacing

“…The implantation of His bundle lead has been explained thoroughly elsewhere8 ‐ 9; briefly, the SelectSecure MRI‐SureScan 3830 lead (Medtronic, Minneapolis, MN, USA) was advanced through a Medtronic C315 His catheter introducer with the distal electrode/screw located just at the tip of the catheter. We mapped the septum, and then we paced and checked the His bundle capture: either selective (capture of only the His bundle with or without correction of the LBBB) or nonselective 12 (capture of the His bundle and adjacent myocardium, with or without correction of the LBBB).…”

“…These benefits of HBP were reported for the first time by Narula and El‐Sherif et al, 3,4 and they are physiopathologically supported by the theory of the longitudinal dissociation in the His Bundle. Therefore, in patients with an indication for cardiac resynchronization therapy (CRT), p‐HBP could be an alternative to or even replace classic CRT via the coronary sinus, 5‐9 as it achieves physiological biventricular activation through the native conduction system.…”

“…Therefore, in patients with an indication for cardiac resynchronization therapy (CRT), p-HBP could be an alternative to or even replace classic CRT via the coronary sinus, [5][6][7][8][9] as it achieves physiological biventricular activation through the native conduction system. But nevertheless, an important limitation is that HBP cannot always correct the LBBB, and there is a lack of evidence to predict the response to HBP (narrowing the QRS or not), based on the basal electrocardiographic patterns of LBBB.…”

The year in cardiovascular medicine 2020: arrhythmias

“…In 2020, a few studies indicated that HBP may be equal or superior to conventional biventricular pacing (BVP) with regard to acute hemodynamic improvement, reverse remodeling and clinical outcome. [43][44][45] In 2020, LBBAP was only 3 years old but attracted already considerable interest. For LBBAP, the 3830 lead is introduced transvenously and subsequently screwed through the interventricular septum until the tip of the lead is (almost) at the većao se s 5 u 2014. na 75 u 2018. godini.…”

“…Tijekom 2020. godine nekoliko je istraživanja pokazalo da bi HBP mogao biti jednako dobar ili superiorniji od konvencionalne biventrikularne elektrostimulacije (BVP) s obzirom na akutno hemodinamsko poboljšanje, reverzno remodeliranje i klinički ishod. [43][44][45] Godine 2020. LBBAP je imao samo 3 godine, ali je već privukao znatan interes.…”