Francesco Zanon1, Kenneth A Ellenbogen2, Gopi Dandamudi3, Parikshit S Sharma4, Weijian Huang5, Daniel L Lustgarten6, Roderick Tung7, Hiroshi Tada8, Jayanthi N Koneru2, Tracy Bergemann9, Dedra H Fagan9, John Harrison Hudnall9, Pugazhendhi Vijayaraman10. 1. Arrhythmia and Electrophysiology Unit, Cardiology Department, Santa Maria Della Misericordia Hospital, 140, Viale Tre Martiri, Rovigo, Italy. 2. Division of Cardiology, Virginia Commonwealth University, Richmond, VA, USA. 3. Department of Medicine, Krannert Institute of Cardiology, Indiana University School of Medicine, Indianapolis, IN, USA. 4. Division of Cardiology, Rush University Medical Center, Chicago, IL, USA. 5. Department of Cardiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China, The Key Lab of Cardiovascular Disease of Wenzhou, Wenzhou, China. 6. Department of Internal Medicine, Division of Cardiology, University of Vermont College of Medicine, Burlington, VT, USA. 7. University of Chicago Medicine, Center for Arrhythmia Care, Pritzker School of Medicine, Chicago, IL, USA. 8. Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan. 9. Medtronic, plc, Mounds View, MN, USA. 10. Department of Cardiac Electrophysiology, Geisinger Heart Institute, Wilkes-Barre, PA, USA.
Abstract
Aims: Permanent cardiac pacing of the His-bundle restores and retains normal electrical activation of the ventricles. Data on His-bundle pacing (HBP) are largely limited to small single-centre reports, and clinical benefits and risks have not been systematically examined. We sought to systematically examine published studies of patients undergoing permanent HBP and quantify the benefits and risks of the therapy. Methods and results: PubMed, Embase, and Cochrane Library were searched for full-text articles on permanent HBP. Clinical outcomes of interest included implant success rate, procedural and lead complications, pacing thresholds, QRS duration, and ejection fraction at follow-up, and mortality. Data were extracted and summarized. Where possible, meta-analysis of aggregate data was performed. Out of 2876 articles, 26 met the inclusion criteria representing 1438 patients with an implant attempt. Average age of patients was 73 years and 62.1% were implanted due to atrioventricular block. Overall average implant success rate was 84.8% and was higher with use of catheter-delivered systems (92.1%; P < 0.001). Average pacing thresholds were 1.71 V at implant and 1.79 V at >3 months follow-up; although, pulse widths varied at testing. Average left ventricular ejection fractions (LVEFs) were 42.8% at baseline and 49.5% at follow-up. There were 43 complications observed in 907 patients across the 17 studies that reported safety information. Conclusion: Among 26 articles of permanent HBP, the implant success rate averaged 84.8% and LVEF improved by an average of 5.9% during follow-up. Specific reporting of our clinical outcomes of interest varied widely, highlighting the need for uniform reporting in future HBP trials.
Aims: Permanent cardiac pacing of the His-bundle restores and retains normal electrical activation of the ventricles. Data on His-bundle pacing (HBP) are largely limited to small single-centre reports, and clinical benefits and risks have not been systematically examined. We sought to systematically examine published studies of patients undergoing permanent HBP and quantify the benefits and risks of the therapy. Methods and results: PubMed, Embase, and Cochrane Library were searched for full-text articles on permanent HBP. Clinical outcomes of interest included implant success rate, procedural and lead complications, pacing thresholds, QRS duration, and ejection fraction at follow-up, and mortality. Data were extracted and summarized. Where possible, meta-analysis of aggregate data was performed. Out of 2876 articles, 26 met the inclusion criteria representing 1438 patients with an implant attempt. Average age of patients was 73 years and 62.1% were implanted due to atrioventricular block. Overall average implant success rate was 84.8% and was higher with use of catheter-delivered systems (92.1%; P < 0.001). Average pacing thresholds were 1.71 V at implant and 1.79 V at >3 months follow-up; although, pulse widths varied at testing. Average left ventricular ejection fractions (LVEFs) were 42.8% at baseline and 49.5% at follow-up. There were 43 complications observed in 907 patients across the 17 studies that reported safety information. Conclusion: Among 26 articles of permanent HBP, the implant success rate averaged 84.8% and LVEF improved by an average of 5.9% during follow-up. Specific reporting of our clinical outcomes of interest varied widely, highlighting the need for uniform reporting in future HBP trials.
Authors: V S Prakash; Anupama V Hegde; U M Nagamalesh; S Ramkumar; Y Sai Krishna; Varsha Rakshitha Prakash; Archana Ratna Potluri Journal: Indian Heart J Date: 2020-05-29