Daniel L Lustgarten1, Eric M Crespo2, Irina Arkhipova-Jenkins3, Robert Lobel4, Joseph Winget4, Jodi Koehler3, Evan Liberman3, Todd Sheldon3. 1. Department of Medicine at the University of Vermont School of Medicine and Fletcher Allen Health Care, Burlington, Vermont; The Cardiovascular Research Institute, Burlington, Vermont. Electronic address: daniel.lustgarten@vtmednet.org. 2. Division of Cardiology, Hartford Hospital, Hartford, Connecticut. 3. Medtronic Inc., Mounds View, Minnesota. 4. Department of Medicine at the University of Vermont School of Medicine and Fletcher Allen Health Care, Burlington, Vermont.
Abstract
BACKGROUND:Cardiac resynchronization therapy (CRT) typically is attempted with biventricular pacing (BiVP). One-third of patients are nonresponders. His-bundle pacing (HBP) has been evaluated as an alternative means of effecting CRT because it generates truly physiologic ventricular activation, as evidenced in part by the morphologic identity between normally conducted and paced QRS complexes. OBJECTIVE: The purpose of this study was to assess the feasibility of, and clinical response to, permanent HBP as an alternative to BiVP in CRT-indicated patients. METHODS: Patients were implanted with a right atrial pacing lead, defibrillation lead, left ventricular (LV) lead via the coronary sinus, and HBP lead. His and LV leads were plugged into the LV port via a Y-adapter. After successful implant, patients were randomized in single patient-blinded fashion to either HBP or BiVP. After 6 months, patients were crossed over to the other pacing modality and followed for another 6 months. Quality-of-life assessments, echocardiographic measurements, New York Heart Association classification, and 6-minute hall walk test were obtained at baseline and at each 6-month follow-up. RESULTS:Twenty-nine patients were enrolled; 21 (72%) demonstratedelectrical resynchronization (QRS narrowing) at implant. Twelve patients completed the crossover analysis at 1 year. Clinical outcomes (quality of life, New York Heart Association functional class, 6-minute hall walk test, LV ejection fraction) were significantly improved for both pacing modes compared with baseline measures. CONCLUSION: In this crossover comparison between HBP and BiVP, HBP was found to effect an equivalent CRT response. QRS narrowing was observed in 21 of 29 patients, suggesting this approach may be feasible in more patients with left bundle branch block than previously assumed.
RCT Entities:
BACKGROUND: Cardiac resynchronization therapy (CRT) typically is attempted with biventricular pacing (BiVP). One-third of patients are nonresponders. His-bundle pacing (HBP) has been evaluated as an alternative means of effecting CRT because it generates truly physiologic ventricular activation, as evidenced in part by the morphologic identity between normally conducted and paced QRS complexes. OBJECTIVE: The purpose of this study was to assess the feasibility of, and clinical response to, permanent HBP as an alternative to BiVP in CRT-indicated patients. METHODS:Patients were implanted with a right atrial pacing lead, defibrillation lead, left ventricular (LV) lead via the coronary sinus, and HBP lead. His and LV leads were plugged into the LV port via a Y-adapter. After successful implant, patients were randomized in single patient-blinded fashion to either HBP or BiVP. After 6 months, patients were crossed over to the other pacing modality and followed for another 6 months. Quality-of-life assessments, echocardiographic measurements, New York Heart Association classification, and 6-minute hall walk test were obtained at baseline and at each 6-month follow-up. RESULTS: Twenty-nine patients were enrolled; 21 (72%) demonstrated electrical resynchronization (QRS narrowing) at implant. Twelve patients completed the crossover analysis at 1 year. Clinical outcomes (quality of life, New York Heart Association functional class, 6-minute hall walk test, LV ejection fraction) were significantly improved for both pacing modes compared with baseline measures. CONCLUSION: In this crossover comparison between HBP and BiVP, HBP was found to effect an equivalent CRT response. QRS narrowing was observed in 21 of 29 patients, suggesting this approach may be feasible in more patients with left bundle branch block than previously assumed.
Authors: Jason Payne; Ann C Garlitski; Jonathan Weinstock; Munther Homoud; Christopher Madias; N A Mark Estes Journal: J Interv Card Electrophysiol Date: 2018-08-13 Impact factor: 1.900
Authors: Alexandra E Teng; Daniel L Lustgarten; Pugazhendhi Vijayaraman; Roderick Tung; Kalyanam Shivkumar; Galen S Wagner; Olujimi A Ajijola Journal: Am J Cardiol Date: 2016-05-28 Impact factor: 2.778