Biventricular versus His bundle pacing after atrioventricular node ablation in heart failure patients with narrow QRS

Žižek, David; Antolič, Bor; Meznar, A Zupan; Zavrl-Džananović, Dinko; Jan, Matevž; Štublar, Jernej; Pernat, Andrej

doi:10.1080/00015385.2021.1903196

Cited by 22 publications

(19 citation statements)

References 25 publications

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“…Huang et al [ 12 ] noted that NYHA classification improved to 1.4 ± 0.4 after 1 year of HBP from the baseline 2.9 ± 0.6 in patients with reduced LVEF. Symptomatic benefits of CSP modalities combined with AVNA were also demonstrated in similar studies [ 19 , 29 ]. The present study did not demonstrate significant NYHA class or diuretics intake decline in BiV group, short follow-up did not allow deeper evaluation of potential clinical benefits.…”

Section: Discussionsupporting

confidence: 57%

“…The procedure was performed as previously described [ 11 , 19 , 21 ]. In short, a 4.1 Fr bipolar active fixation lead (SelectSecure 3830, Medtronic, Minneapolis, MN, USA) and dedicated delivery sheath (C315His or C304, Medtronic, Minneapolis, MN, USA) were used for His bundle area mapping under fluoroscopy.…”

Section: Methodsmentioning

confidence: 99%

“…AVNA was performed following pacemaker implantation. The technique has been described previously [ 12 , 15 , 17 , 19 ]. The lower pacing rate was temporarily set to 40 bpm for the duration of the procedure.…”

Section: Methodsmentioning

confidence: 99%

“…Recommended pacing modalities are either BIV or HBP [ 18 ]. Some observational studies already proved better clinical and echocardiographic outcomes of HBP compared to BIV in symptomatic AF patients who underwent AVNA [ 19 ]. However, no previously published study offers comparison of BIV pacing with both CSP modalities.…”

Section: Introductionmentioning

confidence: 99%

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Biventricular versus Conduction System Pacing after Atrioventricular Node Ablation in Heart Failure Patients with Atrial Fibrillation

Ivanovski

Mrak

Meznar

et al. 2022

JCDD

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Conduction system pacing (CSP) modalities, including His-bundle pacing (HBP) and left bundle branch pacing (LBBP), are increasingly used as alternatives to biventricular (BiV) pacing in heart failure (HF) patients scheduled for pace and ablate strategy. The aim of the study was to compare clinical outcomes of HF patients with refractory AF who received either BiV pacing or CSP in conjunction with atrio-ventricular node ablation (AVNA). Fifty consecutive patients (male 48%, age 70 years (IQR 9), left ventricular ejection fraction (LVEF) 39% (IQR 12)) were retrospectively analysed. Thirteen patients (26%) received BiV pacing, 27 patients (54%) HBP and 10 patients (20%) LBBP. All groups had similar baseline characteristics and acute success rate. While New York Heart. Association (NYHA) class improved in both HBP (p < 0.001) and LBBP (p = 0.008), it did not improve in BiV group (p = 0.096). At follow-up, LVEF increased in HBP (form 39% (IQR 15) to 49% (IQR 16), p < 0.001) and LBBP (from 28% (IQR 13) to 40% (IQR 13), p = 0.041), but did not change in BiV group (p = 0.916). Conduction system pacing modalities showed superior symptomatic and echocardiographic improvement compared to BiV pacing after AVNA. With more stable pacing parameters, LBBP could present a more feasible pacing option compared to HBP.

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Section: Discussionsupporting

confidence: 57%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Biventricular versus Conduction System Pacing after Atrioventricular Node Ablation in Heart Failure Patients with Atrial Fibrillation

Ivanovski

Mrak

Meznar

et al. 2022

JCDD

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“…In recent years, conduction system pacing (CSP), delivered through His-Bundle pacing (HBP) ( Vijayaraman et al, 2018 ) or Left Bundle pacing (LBP) ( Zhang et al, 2019 ) have emerged as technologies which are not only viable alternatives to CRT, but potential first-line options in selected patients ( Figure 1 ). ( Arnold et al, 2018 ; Upadhyay et al, 2019 ; Karpenko et al, 2021 ; Žižek et al, 2021 ) Growing indications for CSP will create a growing patient populations requiring long term management of CSP systems.…”

Section: Introductionmentioning

confidence: 99%

Transvenous lead extraction in conduction system pacing

Wijesuriya

Elliott²,

Mehta³

et al. 2022

Front. Physiol.

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Conduction System Pacing (CSP) delivered by His Bundle Pacing (HBP) or Left Bundle Pacing (LBP) are exciting novel interventions in the field of Cardiac Resynchronization Therapy (CRT). As the evidence base for CSP grows, the volume of implants worldwide is projected to rise significantly in the coming years. As such, physicians will be confronted with increasingly prevalent and vital issues arising in long-term follow up, including the management of infected, malfunctioning, or redundant CSP leads. Transvenous lead extraction (TLE) is the first-line option for removal of pacing leads when indicated in these circumstances. The evidence base for TLE in the context of CSP is still in its infancy. In this article, we first provide a brief overview of TLE. We then examine the data on the long-term performance of HBP leads. Next, we describe the features of the Medtronic Select Secure 3,830 lead, and how experience of TLE of this lead in the paediatric population has informed our practice. Finally, we review the current evidence for TLE in HBP and LBP, and discuss how future studies can address gaps in our current knowledge.

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His bundle combined with deep septal left bundle branch area pacing for atrial fibrillation prior to atrioventricular node ablation

Nam

O'Sullivan

Tonchev

et al. 2022

Journal of Arrhythmia

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Background: To mitigate the risk of dyssynchrony-induced cardiomyopathy, international guidelines advocate His bundle pacing (HBP) with a ventricular backup lead prior to atrioventricular node ablation in treatment-refractory atrial fibrillation and normal left ventricular ejection fraction. As a result of concerns with long-term pacing parameters associated with HBP, this case series reports an adopted strategy of HBP combined with deep septal left bundle branch area pacing (dsLBBAP) in this patient cohort, enabling intrapatient comparison of the two pacing methods. Methods and Results:Eight patients aged 72 ± 10 years (left ventricular ejection fraction 53 ± 4%) underwent successful combined HBP and dsLBBAP implant prior to AV node ablation. Intrinsic QRS duration was 118 ± 46 ms. When compared to dsLBBAP, HBP had lower sensed ventricular amplitude (2.4 ± 1.1 vs. 15 ± 5.3 V, p = .001) and lower lead impedance (522 ± 57 vs. 814 ± 171ohms, p = .02), but shorter paced QRS duration (101 ± 20 vs. 119 ± 17 ms, p = .02). HBP pacing threshold was 1.0 ± 0.6 V at 1 ms pulse width, and dsLBBAP pacing threshold was 0.5 ± 0.2 V at 0.4 ms pulse width.Five patients underwent cardiac CT showing adequate dsLBBAP ventricular septal penetration (8.6 ± 1.3 mm depth, 2.4 ± 0.5 mm distance from left ventricular septal wall). No complications occurred during a mean follow-up duration of 121 ± 92 days. Conclusions:Combined HBP and dsLBBAP pacing is a feasible approach as a pace and ablate strategy for atrial fibrillation refractory to medical therapy.

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Biventricular versus His bundle pacing after atrioventricular node ablation in heart failure patients with narrow QRS

Cited by 22 publications

References 25 publications

Biventricular versus Conduction System Pacing after Atrioventricular Node Ablation in Heart Failure Patients with Atrial Fibrillation

Biventricular versus Conduction System Pacing after Atrioventricular Node Ablation in Heart Failure Patients with Atrial Fibrillation

Transvenous lead extraction in conduction system pacing

His bundle combined with deep septal left bundle branch area pacing for atrial fibrillation prior to atrioventricular node ablation

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