Physiologic Resynchronization Therapy: A Case of His Bundle Pacing Reversing Physiologic Conduction in a Patient with CHF and LBBB During 2 Years of Observation

Abstract

This is a case of a patient with congestive heart failure and left bundle branch block who was referred for cardiac resynchronization therapy implantation. Instead, a His bundle pacing was achieved with a narrow QRS complex. During 27 months of observation, the patient improved dramatically from NYHA class IV to I. Echo parameters improved significantly the LV diameter from 75/50 to 60/40 mm, EF from 28 to 50%, and mitral regurgitation from 4 to 2°.

Utilization of Permanent His‐Bundle Pacing for Management of Proarrhythmia Related to Biventricular Pacing

“…It is important to note, however, that HBP has been demonstrated to narrow the QRS complex and recruit the left bundle branch even in patients with a preexisting left bundle branch block, presumably because of longitudinal dissociation of conduction. [11][12][13][14][15] This suggests potential wider applicability of this pacing technique. In patients with proarrhythmia related to BVP, HBP should be strongly considered.…”

“…For physiologic HBP to succeed an intact distal His‐Purkinje system is required, which may limit its usefulness in patients with distal bundle branch block or intraventricular conduction block. It is important to note, however, that HBP has been demonstrated to narrow the QRS complex and recruit the left bundle branch even in patients with a preexisting left bundle branch block, presumably because of longitudinal dissociation of conduction . This suggests potential wider applicability of this pacing technique.…”

Strategies to improve cardiac resynchronization therapy

“…125 The idea has been revisited in several small studies, which showed echocardiographic and clinical benefit of CRT in patients with LBBB. 126,127 Conceptually, pacing in the bundle of His can lead to resynchronization only if the electrode is positioned distally to the block, which implies that the block is located quite proximally in a notable number of patients with LBBB. Improvement of tools for pacing in the bundle of His, and of methods for identifying patients that might benefit, might extend the scope of CRT.…”

Electrical and Mechanical Cardiac Resynchronisation by Novel Direct His-bundle Pacing in a Heart Failure Patient

“…Four patients of this group with an indication for CRT were successfully treated by DHBP. These patients, in addition to a scarce number of cases recently reported [2,5], represent the only population described in which CRT was performed by DHBP. The potential value of this approach is to achieve synchronous biventricular activation preserving the intrinsic activation sequence of both ventricles with the use of a single lead system; a method which seems to be more physiologic and, a priori, less expensive and simpler than guided coronary sinus cannulation.…”