Gopi Dandamudi1, Joel Simon2, Oscar Cano3, Vivak Master4, Jacob S Koruth5, Angela Naperkowski6, Adam C Kean2, Robert Schaller7, Kenneth A Ellenbogen4, Jordana Kron4, Pugazhendhi Vijayaraman6. 1. Division of Cardiology, CHI Franciscan, Tacoma, Washington, USA; Division of Cardiology, Indiana University School of Medicine, Indianapolis, Indiana, USA. Electronic address: gopidandamudi@chifranciscan.org. 2. Division of Cardiology, Indiana University School of Medicine, Indianapolis, Indiana, USA. 3. Division of Cardiology, Hospital Universitari Politècnic La Fe, Valencia, Spain. 4. Division of Cardiology, Virginia Commonwealth University, Richmond, Virginia, USA. 5. Division of Cardiology, Mount Sinai School of Medicine, New York, New York, USA. 6. Division of Cardiology, Geisinger Heart Institute, Wilkes-Barre, Pennsylvania, USA. 7. Division of Cardiology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA.
Abstract
OBJECTIVES: This study retrospectively assessed the safety and efficacy of permanent His bundle pacing (HBP) in patients with congenital complete heart block (CCHB). BACKGROUND: HBP has become an accepted form of pacing in adults. Its role in CCHB is not known. METHODS: Seventeen patients with CCHB who underwent successful HBP were analyzed at 6 academic centers between 2016 and 2019. Nine patients had de novo implants, and 8 patients had previous right ventricular (RV) leads. Three RV paced patients had reduced left ventricular ejection fractions at the time of HBP. Implant/follow-up device parameters, New York Heart Association functional class, QRS duration, and left ventricular ejection fraction data were analyzed. RESULTS: Patients' mean age was 27.4 ± 11.3 years, 59% were women, and mean follow-up was 385 ± 279 days. The following parameters were found to be statistically significant between implant and follow-up, respectively: impedance, 602 ± 173 Ω versus 460 ± 80 Ω (p < 0.001); and New York Heart Association functional class, 1.7 ± 0.9 versus 1.1 ± 0.3 (p = 0.014). In patients with previous RV pacing, HBP resulted in a significant decrease in QRS duration: 167.1 ± 14.3 ms versus 118.3 ± 13.9 ms (p < 0.0001). In de novo implants, HBP resulted in increases in QRS duration compared with baseline: 111.1 ± 19.4 ms versus 91.0 ± 4.8 ms (p = 0.016). Other parameters exhibited no statistically significant differences. During follow-up, 2 patients required lead revision due to elevated pacing thresholds. CONCLUSIONS: HBP seems to be safe and effective, with improvement in clinical outcomes in patients with CCHB. Larger studies with longer follow-up periods are required to confirm our findings.
OBJECTIVES: This study retrospectively assessed the safety and efficacy of permanent His bundle pacing (HBP) in patients with congenital complete heart block (CCHB). BACKGROUND: HBP has become an accepted form of pacing in adults. Its role in CCHB is not known. METHODS: Seventeen patients with CCHB who underwent successful HBP were analyzed at 6 academic centers between 2016 and 2019. Nine patients had de novo implants, and 8 patients had previous right ventricular (RV) leads. Three RV paced patients had reduced left ventricular ejection fractions at the time of HBP. Implant/follow-up device parameters, New York Heart Association functional class, QRS duration, and left ventricular ejection fraction data were analyzed. RESULTS: Patients' mean age was 27.4 ± 11.3 years, 59% were women, and mean follow-up was 385 ± 279 days. The following parameters were found to be statistically significant between implant and follow-up, respectively: impedance, 602 ± 173 Ω versus 460 ± 80 Ω (p < 0.001); and New York Heart Association functional class, 1.7 ± 0.9 versus 1.1 ± 0.3 (p = 0.014). In patients with previous RV pacing, HBP resulted in a significant decrease in QRS duration: 167.1 ± 14.3 ms versus 118.3 ± 13.9 ms (p < 0.0001). In de novo implants, HBP resulted in increases in QRS duration compared with baseline: 111.1 ± 19.4 ms versus 91.0 ± 4.8 ms (p = 0.016). Other parameters exhibited no statistically significant differences. During follow-up, 2 patients required lead revision due to elevated pacing thresholds. CONCLUSIONS: HBP seems to be safe and effective, with improvement in clinical outcomes in patients with CCHB. Larger studies with longer follow-up periods are required to confirm our findings.
Authors: Giuseppe Pio Piemontese; Matteo Ziacchi; Giovanni Statuto; Andrea Angeletti; Giulia Massaro; Lorenzo Bartoli; Mauro Biffi Journal: Ann Noninvasive Electrocardiol Date: 2022-03-02 Impact factor: 1.485