Brady‐arrhythmias in patients with atrial fibrillation and heart failure of reduced ejection fraction: is his‐bundle pacing superior to biventricular pacing？

Abstract

Objective To investigate the efficacy and safety of His‐bundle pacing (HBP) compared with the traditional biventricular pacing (BVP) on patients with brady‐arrhythmias, who suffer from permanent atrial fibrillation (AF) and heart failure with reduced ejection fraction (HFrEF). Methods All patients with brady‐arrhythmias, permanent AF and HFrEF were continuously enrolled from January 2017 to July 2019 and followed up for at least 12 months. The differences in QRS duration (QRSd), New York Heart Association (NYHA) classification, left ventricular ejection fraction (LVEF), tricuspid regurgitation grade, mitral regurgitation grade, left ventricular end‐diastolic diameter (LVEDD), and left atrial size were compared. Results A total of 52 patients were enrolled: 37 patients were with HBP and 15 patients with BVP. There was no electrode dislodged, perforation, infection or thrombosis during the follow‐up of 18.12 ± 4.45 months. The success rate for HBP implantation was 88.10%. The capture threshold of his‐bundle and the threshold of the left ventricular lead remained stable during follow‐up. LVEF increased to higher than 50% in 11 patients with HBP (29.73%). The NYHA classification (both p < .001), LVEF (both p < .001) and LVEDD improved significantly during the follow‐up in both groups. NYHA (p = .030), LVEF (p = .013), and LVEDD (p = .003) improved in patients with HBP compared with BVP. Conclusion HBP was safe and more effective in improving the cardiac function and remodeling in patients with brady‐arrhythmias, permanent AF and HFrEF compared with BVP.

Tricuspid regurgitation in His bundle pacing: A systematic review

“…We systematically assessed studies on HBP with an assessment of TR, which comprised of 9 original research articles and 1 case series reporting nearly 5 years of experience from 546 patients across centers around the world (Grieco et al, 2021 ; Hasumi et al, 2018 ; Hu et al, 2020 ; Hu et al, 2021 ; Huang et al, 2019 ; Ma et al, 2021 ; Shan et al, 2018 ; Vijayaraman et al, 2017 ; Wu et al, 2021 ; Ye et al, 2021 ). This is the first systematic analysis of a patient cohort to demonstrate the incidence of TR with HBP and its quantification before and after the procedural follow‐up, demonstrating its effects on ventricular synchrony.…”

“…HBP can also normalize conduction in patients with bundle branch block (BBB), hence, it has a role as an alternative to CRT (Abdelrahman et al, 2018 ). As HBP lead can be implanted above tricuspid annulus, its effect on TV morphology is minimal, leading to reversal of TR (Grieco et al, 2021 ; Hasumi et al, 2018 ; Hu et al, 2020 ; Hu et al, 2021 ; Huang et al, 2019 ; Ma et al, 2021 ; Shan et al, 2018 ; Vijayaraman et al, 2017 ; Wu et al, 2021 ; Ye et al, 2021 ). In this systematic review, we provide an association of TR in patients undergoing HBP.…”

His-Purkinje System Pacing versus Biventricular Pacing in clinical efficacy: A Systematic Review and Meta-Analysis

“…1), and 88 records were left after exclusion of duplications. Of these, by screening via title and abstract, 67 articles were subsequently excluded, and 12 studies (14,(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37) were included in this meta-analysis after further excluding single-arm studies, study protocols, and studies with irrelevant outcomes.…”

“…Patients who received HPSP (LBBaP or HBP) and BVP were generally frequency-matched on age and sex (Table 1), period of the follow up were six months in seven studies, 12 months in two studies, 14 months, 18 months and 24 months in one study each. All patients have HF and CRT indication in 12 studies (14,(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37). In seven studies (28-32, 34, 35), the majority of the subjects had non-ischemic cardiomyopathy (73%, n = 326).…”

Conduction system pacing versus biventricular pacing: Reduced repolarization heterogeneity in addition to improved depolarization

“…[9][10][11] Cardiac conduction system pacing (CSP) involves direct stimulation of the conduction system distal to the level of block, thereby achieving normal activation of one or both ventricles. The beststudied modality is His-bundle pacing (HBP), first demonstrated clinically by Deshmukh et al 12 HBP has been shown to be a viable alternative in patients eligible for BiVP, [13][14][15][16] but is limited by problems such as high pacing thresholds, low sensed R waves, atrial over-sensing, and relatively lower success rates. 14,17 A more recent modality is left-bundle-area pacing (LBAP), first demonstrated by Huang et al, 18 which involves direct stimulation of the fascicles of the left bundle branch distal to site of block via transseptal lead placement.…”