The Effects of His Bundle Pacing Compared to Classic Resynchronization Therapy in Patients with Pacing-Induced Cardiomyopathy

Abstract

Pacing-induced cardiomyopathy (PICM) is among the most common right ventricular pacing complications. Upgrading to cardiac resynchronization therapy (CRT) is the recommended treatment option. Conduction system pacing with His bundle pacing (HBP) has the potential to restore synchronous ventricular activation and can be an alternative to biventricular pacing (BVP). Patients with PICM scheduled for a system upgrade to CRT were included in the prospective cohort study. Either HBP or BVP was used for CRT. Electrocardiographic, clinical, and echocardiographic measurements were recorded at baseline and six-month follow-up. HBP was successful in 44 of 53 patients (83%). Thirty-nine patients with HBP and 22 with BVP completed a 6-month follow-up. HBP led to a higher reduction in QRS duration than BVP, 118.3 ± 14.20 ms vs. 150.5 ± 18.64 ms, p < 0.0001. The improvement in New York Heart Association (NYHA) class by one or two was more common in patients with HBP than those with BiV (p = 0.04). Left ventricular ejection fraction (LVEF) improved in BVP patients from 32.9 ± 7.93% to 43.9 ± 8.07%, p < 0.0001, and in HBP patients from 34.9 ± 6.45% to 48.6 ± 7.73%, p < 0.0001. The improvement in LVEF was more considerable in HBP patients than in BVP patients, p = 0.019. The improvement in clinical outcomes and left ventricle reverse remodeling was more significant with HBP than BVP. HBP can be a valid alternative to BVP for upgrade procedures in PICM patients.

The Specific Value of Upgrading to Left Bundle Branch Pacing in Patients with Pacing-Induced Cardiomyopathy or Non-Pacing-Induced Cardiomyopathy: A Retrospective Study

“…In the study of PICM, most scholars seemed to be only interested in the preoperative versus postoperative comparison of emerging physiological pacing (CRT, HBP, and LBBP). For example, Khurshid et al and Gardas et al respectively reported that CRT and HBP might improve left ventricular electrical and mechanical synchronization (5,20), and Ye et al and Qian et al also reported that LBBP upgrade was likely to improve the cardiac function and clinical outcomes of PICM patients (4,21). All the points mentioned above were consistent with the findings we derived.…”

Reversal of pacing-induced cardiomyopathy after left bundle branch area pacing: a case report

“…Another situation that LBBAP might be preferred to CRT is PICM as in our case. As we described before, a previous study observed that his bundle pacing was associated with a better improvement in LVEF than CRT in patients with PICM [12]. Although LBBAP is different from his bundle pacing, both target conduction system pacing, which is believed to be more physiologic than biventricular pacing.…”

“…The therapeutic effect of CRT among patients with PICM has also been shown by a recent meta-analysis [11]. There is a report that his bundle pacing might be more effective in improving LVEF than CRT among PICM patients [12]. However, it should be cautiously interpreted because the study has a limited cohort size and there was no guarantee that CRT was fully optimized.…”

The specific value of upgrading to left bundle branch area pacing in patients with pacing‐induced cardiomyopathy or non‐pacing‐induced cardiomyopathy related upgrade status: A retrospective study

“…and Gardas et al. respectively reported that CRT and HBP might improve left ventricular electrical and mechanical synchronization, 6,20 and Ye et al. and Qian et al.…”