Permanent His Bundle Pacing for Cardiac Resynchronization Therapy in Patients With Heart Failure and Right Bundle Branch Block.
Background Cardiac resynchronization therapy utilizing biventricular pacing is an effective therapy for patients with left ventricular (LV) systolic dysfunction, left bundle branch block, and heart failure. Benefits of biventricular pacing may be limited in patients with right bundle branch block (RBBB). Permanent His bundle pacing (HBP) has recently been reported as an option for cardiac resynchronization therapy. The aim of the study was to assess the feasibility and outcomes of HBP in patients with RBBB and heart failure. Methods HBP was attempted as a primary or rescue (failed LV lead implant) strategy in patients with reduced LV ejection fraction, RBBB, QRS duration ≥120 ms, and New York Heart Association class II to IV heart failure. Implant characteristics, New York Heart Association functional class, and echocardiographic data were assessed in follow-up. Results Mean age was 72±10 years, female 15%, with an average LV ejection fraction of 31±10%. HBP was successful in 37 of 39 patients (95%) with narrowing of RBBB in 78% cases. His capture and bundle branch block correction thresholds were 1.1±0.6 V and 1.4±0.7 V at 1 ms, respectively. During a mean follow-up of 15±23 months, there was a significant narrowing of QRS from 158±24 to 127±17 ms ( P=0.0001), increase in LV ejection fraction from 31±10% to 39±13% ( P=0.004), and improvement in New York Heart Association functional class from 2.8±0.6 to 2±0.7 ( P=0.0001) with HBP. Increase in capture threshold occurred in 3 patients. Conclusions Permanent HBP was associated with significant narrowing of QRS duration and improvement in LV function in patients with RBBB and reduced LV ejection fraction. Permanent HBP is a promising option for cardiac resynchronization therapy in patients with RBBB and reduced LV ejection fraction.
['Sharma|Parikshit S|PS|', 'Naperkowski|Angela|A|', 'Bauch|Terry D|TD|', 'Chan|Joseph Y S|JYS|', 'Arnold|Ahran D|AD|', 'Whinnett|Zachary I|ZI|', 'Ellenbogen|Kenneth A|KA|', 'Vijayaraman|Pugazhendhi|P|']
D000200:Action Potentials D000368:Aged D000369:Aged, 80 and over D002036:Bundle of His D002037:Bundle-Branch Block D058406:Cardiac Resynchronization Therapy D004452:Echocardiography D004562:Electrocardiography D005240:Feasibility Studies D005260:Female D006333:Heart Failure D006339:Heart Rate D006723:Hong Kong D006801:Humans D008131:London D008297:Male D008875:Middle Aged D012189:Retrospective Studies D013318:Stroke Volume D013997:Time Factors D016896:Treatment Outcome D014481:United States D016277:Ventricular Function, Left
cardiac resynchronization therapy patients heart failure right bundle branch block atrial fibrillation