Electrical resynchronization induced by direct His-bundle pacing

Lustgarten, Daniel L.; Calame, Susan; Crespo, Eric M.; Calame, James; Lobel, Robert; Spector, Peter

doi:10.1016/j.hrthm.2009.09.066

Cited by 124 publications

(78 citation statements)

References 16 publications

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“…20 Interestingly, preliminary observations have suggested that HIS pacing may be useful and may yield significant narrowing of the QRS complex in some patients requiring CRT if the site of an intra-Hisian lesion responsible for left bundle-branch block is above the pacing site. 21 However, in these cases, the relative, and possibly additive, effect of His and LV pacing would require specific assessment. In a previous study, we directly compared the changes in LV function associated with pacing from the HIS and the LV in a population of patients with no indications for CRT, using pressure-volume plane analysis.…”

Section: Strik Et Almentioning

confidence: 99%

Simultaneous His Bundle and Left Ventricular Pacing for Optimal Cardiac Resynchronization Therapy Delivery

Padeletti

Pieragnoli

Ricciardi

et al. 2016

Circ: Arrhythmia and Electrophysiology

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We enrolled 12 consecutive heart failure patients with indications for CRT. The Institutional Review Board approved the protocol, © 2016 American Heart Association, Inc. Circ Arrhythm Electrophysiol Original ArticleBackground-Previous studies have investigated the role of intrinsic conduction in optimizing cardiac resynchronization therapy. We investigated the role of fusing pacing-induced activation and intrinsic conduction in cardiac resynchronization therapy by evaluating the acute hemodynamic effects of simultaneous His-bundle (HIS) and left ventricular (LV) pacing. Methods and Results-We studied 11 patients with systolic heart failure and left bundle-branch block scheduled for cardiac resynchronization therapy implantation. On implantation, LV pressure-volume data were determined via conductance catheter. Standard leads were placed in the right atrium, at the right ventricular apex, and in a coronary vein. An additional electrode was temporarily positioned in the HIS. The following pacing configurations were systematically assessed: standard biventricular (right ventricular apex+LV), LV-only, HIS, simultaneous HIS and LV (HIS+LV). Each configuration was compared with the AAI mode at multiple atrioventricular delays (AVD). In comparison with the AAI, right ventricular apex+LV and LV-only pacing resulted in improved stroke volume (85±32 mL and 86±33 mL versus 58±23 mL; P<0.001), stroke work, maximum pressure derivative, and systolic dyssynchrony at individually optimized AVD. The optimal AVD was close to the P-H interval in the majority of patients. By contrast, HIS-LV pacing improved hemodynamic indexes at all AVD (stroke volume >76 mL at all fixed intervals and 88±31 mL at optimal interval; all P<0.001). Conclusions-Standard right ventricular apex+LV and LV-only pacing enhanced systolic function and LV synchrony at individually optimized AVD close to the measured intrinsic P-H interval. By contrast, HIS+LV pacing yielded improvements, regardless of AVD setting. These findings support the hypothesis of the crucial role of intrinsic right ventricular conduction in optimal cardiac resynchronization therapy delivery. (Circ Arrhythm Electrophysiol. 2016;9:e003793.

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Section: Strik Et Almentioning

confidence: 99%

Simultaneous His Bundle and Left Ventricular Pacing for Optimal Cardiac Resynchronization Therapy Delivery

Padeletti

Pieragnoli

Ricciardi

et al. 2016

Circ: Arrhythmia and Electrophysiology

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“…Similarly, Lustgarten et al assessed DHBP in patients with standard indications for biventricular pacing, and noted that it resulted in a significantly narrower QRS as compared with native conduction and biventricular pacing (mean QRS duration: native 171 ms, DHBP 148 ms, and BiV 158 ms, po0.0001). 7 This finding of electrical resynchronization was revisited by the same group of researchers again in a crossover comparison study assessing the feasibility of, and the clinical response to, permanent HBP as an alternative to BiVP in CRT-indicated patients. It was found that HBP can elicit 6-month CRT clinical responses similar to those of BiVP.…”

Section: Discussionmentioning

confidence: 99%

An Interesting Case of Permanent His-Bundle Pacing and a Review of the Current Literature

Ezzeddine

Dandamudi

2017

JICRM

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ABSTRACT. Permanent His-bundle pacing (HBP) is a true physiological form of ventricular pacing that has been shown in recent years to be both safe and feasible in clinical practice. However, there are limited data about its long-term performance, especially when compared with both right ventricular and biventricular pacing. In this article, we present a thought-provoking case study that illustrates the usefulness of permanent HBP in a patient with long-standing complete infranodal heart block and progressive heart failure, and discuss the current literature highlighting the evidence behind this form of permanent pacing.

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“…10,11 The QRS with selective capture will be essentially identical to native conduction, whereas nonselective QRS morphology will have a characteristic pseudo-delta wave akin to pre-excitation associated with an anteroseptal pathway. If the His pacing site is subvalvular, His capture is more likely to be encountered at higher outputs (resulting in non-selective His bundle capture, described elsewhere 4,9,12 and below), with lower output resulting in ventricular capture only prior to loss of capture (Video 2 and Figure 4). This pacing site is the one most often chosen when para-Hisian pacing maneuvers are used to characterize the presence or absence of retrograde-conducting accessory pathways.…”

Section: Methodsmentioning

confidence: 99%

“…5 More recently, with the advent of site-selective lead delivery systems, His bundle pacing has been garnering increased interest, with recent publications demonstrating feasibility and clinical utility in the settings of patients with and without intrinsic His-Purkinje disease. [6][7][8][9] There are nuances and challenges, particularly given that we are currently at a relatively nascent stage with respect to developing delivery and pacing systems specific to the His bundle electrophysiologic target. What follows is a systematic approach to performing permanent His bundle pacing using pacing leads that are currently available commercially.…”

Section: Introductionmentioning

confidence: 99%

Step-wise Approach to Permanent His Bundle Pacing

Lustgarten¹

2016

JICRM

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ABSTRACT. There has been a recent upsurge of interest in permanent His bundle pacing, given increased understanding and appreciation of the role dyssynchronous ventricular activation plays in congestive heart failure and atrial fibrillation. Permanent His bundle pacing gives implanters the ability to avoid causing ventricular dyssynchrony in patients dependent on ventricular pacing, and can provide an alternative means to implementing cardiac resynchronization therapy in patients with bundle branch disease and congestive heart failure. This paper describes a step-wise approach to implanting permanent His bundle pacing leads, with a clear demonstration of techniques and observations encountered during the course of typical His bundle lead implantations, including consideration of potential pitfalls and workarounds.

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Electrical resynchronization induced by direct His-bundle pacing

Cited by 124 publications

References 16 publications

Simultaneous His Bundle and Left Ventricular Pacing for Optimal Cardiac Resynchronization Therapy Delivery

Simultaneous His Bundle and Left Ventricular Pacing for Optimal Cardiac Resynchronization Therapy Delivery

An Interesting Case of Permanent His-Bundle Pacing and a Review of the Current Literature

Step-wise Approach to Permanent His Bundle Pacing

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