Olujimi A Ajijola1, Gaurav A Upadhyay2, Carlos Macias1, Kalyanam Shivkumar1, Roderick Tung3. 1. UCLA Cardiac Arrhythmia Center, David Geffen School of Medicine at UCLA, Los Angeles, California. 2. The University of Chicago Medicine, Center for Arrhythmia Care, Pritzker School of Medicine, Chicago, Illinois. 3. The University of Chicago Medicine, Center for Arrhythmia Care, Pritzker School of Medicine, Chicago, Illinois. Electronic address: rodericktung@uchicago.edu.
Abstract
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.
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.
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: Norman C Wang; Aliza Hussain; Evan C Adelstein; Andrew D Althouse; Michael S Sharbaugh; Sandeep K Jain; Alaa A Shalaby; Andrew H Voigt; Samir Saba Journal: Ann Noninvasive Electrocardiol Date: 2018-09-28 Impact factor: 1.468
Authors: Min Soo Cho; Min Ku Chon; Jin Hee Choi; Ki Won Hwang; Jeong-Wook Seo; Robert J Lederman; June Hong Kim; Gi-Byoung Nam Journal: Heart Rhythm Date: 2019-08-30 Impact factor: 6.343