Background
Permanent His-bundle pacing (HBP) has the potential to physiologically normalize wide
QRS duration in patients with bundle branch block and cardiomyopathy.
Objective
The purpose of this study was to assess the feasibility of incorporating a His-bundle
lead for cardiac resynchronization therapy (CRT) in lieu of a coronary sinus lead.
Methods
Patients with an indication for CRT (n = 21) underwent attempted implantation of an
HBP placed into the left ventricular (LV) lead port. Intracardiac intervals, QRS duration,
New York Heart Association functional class, ejection fraction (EF), echocardiography,
and lead characteristics were measured at baseline and at follow-up.
Results
Of the 21 patients in whom implantation was attempted, HBP was successfully implanted
in 16 (age 62 ± 18 years, 4 females, EF 25 ± 8). A significant reduction in mean QRS
was observed, with narrowing from 180 ± 23 ms to 129 ± 13 ms (P <.0001). During the follow-up period, median New York Heart Association functional
class improved from III to II (P <.001), and mean LV EF and left ventricular internal dimension in diastole (LVIDd)
improved from 27% ± 10% to 41% ± 13% (P <.001) and from 5.4 ± 0.4 cm to 4.5 ± 0.3 cm (P <.001), respectively. At median 12-month follow-up, no dislodgments were observed,
and only one patient lost nonselective capture that resolved with increased pacing
output.
Conclusion
Permanent HBP is feasible for patients with an indication for CRT using the LV port
in lieu of a coronary sinus lead. In this initial experience, narrowing of QRS duration
was achieved in 76% of patients with bundle branch block, and improvements in clinical
and echocardiographic measures were observed with HBP. Future prospective comparative
studies with HBP to achieve CRT are justifiable.
Graphical abstract
Graphical Abstract
Keywords
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Article info
Publication history
Published online: April 08, 2017
Footnotes
This study was supported by Grant HL084261 from the National Heart, Lung, and Blood Institute of the National Institutes of Health to Dr. Shivkumar and Grant HL125730 to Dr. Ajijola. Dr Upadhyay receives research support from Medtronic, Inc and Biotronik, Inc. Drs. Ajijola and Upadhyay contributed equally to this manuscript.
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