Clinical Outcomes of Selective Versus Nonselective His Bundle Pacing

Beer, Dominik; Sharma, Parikshit S.; Subzposh, Faiz A.; Naperkowski, Angela; Pietrasik, Grzegorz; Durr, Brendan; Qureshi, Maria; Panikkath, Ragesh; Abdel‐Rahman, Mohamed H.; Williams, Brent A.; Hanifin, Jillian L.; Zimberg, Ryan; Austin, Kelly; Macuch, Brooke; Trohman, Richard G.; Vanenkevort, Erin; Dandamudi, Gopi; Vijayaraman, Pugazhendhi

doi:10.1016/j.jacep.2019.04.008

Cited by 62 publications

(57 citation statements)

References 15 publications

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“…32,33 In an observational study of 640 patients followed up over a mean of 2.8 years, there was no difference in outcome in terms of death and heart failure hospitalizations between selective and nonselective HBP. 34 We observed better acute results in terms of ECG and echocardiographic outcomes on combining HBP with CS pacing (with or without concomitant RV pacing). Our results are consistent with those of others.…”

Section: Discussionmentioning

confidence: 62%

“…Two small randomized trials comparing HBP alone with conventional CRT did not show a significant clinical benefit of HBP alone vs conventional CRT 32,33 . In an observational study of 640 patients followed up over a mean of 2.8 years, there was no difference in outcome in terms of death and heart failure hospitalizations between selective and nonselective HBP 34 …”

Section: Discussionmentioning

confidence: 95%

“…HBP has been studied by some authors as an alternative to conventional CRT [30][31][32][33][34] and by others in conjunction with CS pacing. 35,36 In an acute hemodynamic study, His resynchronization delivered better ventricular resynchronization and greater improvement in hemodynamic parameters than biventricular pacing.…”

Section: Discussionmentioning

confidence: 99%

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Additional benefits of nonconventional modalities of cardiac resynchronization therapy using His bundle pacing

Coluccia¹,

Vitale²,

Corallo³

et al. 2020

Cardiovasc electrophysiol

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Introduction Dyssynchrony persists in many patients despite cardiac resynchronization therapy (CRT). Aim of this proof‐of‐concept study was to achieve better CRT, with a QRS approximating the normal width and axis, by using His bundle pacing (HBP) and nonconventional pacing configurations. Methods and Results In 20 patients with CRT indications, we performed an acute intrapatient comparison between conventional biventricular (CONV) and three nonconventional pacing modalities: HBP alone, His bundle, and coronary sinus pacing (HBP + CS), and HBP + CS plus right ventricular pacing (TRIPLE). Electrical dyssynchrony was assessed by means of QRS width and axis; “quasi‐normal” axis meant an R/S ratio ≥ 1 in leads I and V6 and ≤1 in V1. Mechanical dyssynchrony was assessed by speckle tracking echocardiography. QRS width was 153 ± 18 ms on CONV, shortened to 137 ± 16 ms on HBP + CS (P = .001) and to 130 ± 14 ms on TRIPLE (P = .001), while it remained unchanged on HBP (159 ± 32 ms; P = .17). The rate of patients with “quasi‐normal” axis was 5% on CONV, and increased to 90% on HBP (P = .0001), to 63% on HBP + CS (P = .001), and to 44% on TRIPLE (P = .02). On radial strain analysis, the time‐to‐peak difference between anteroseptal and posterolateral segments was 143 ± 116 ms on CONV, shortened to 121 ± 127 ms on HBP (P = .79), to 67 ± 70 ms on HBP + CS (P = .02), and to 76 ± 55 ms on TRIPLE (P = .05). On discharge, HBP was chosen in 15% of patients, HBP + CS in 55%, and TRIPLE in 30%; CONV was never chosen. Conclusion Nonconventional modalities of CRT provide acute additional electrical and mechanical resynchronization. An interpatient variability exists.

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Section: Discussionmentioning

confidence: 62%

Section: Discussionmentioning

confidence: 95%

See 1 more Smart Citation

Additional benefits of nonconventional modalities of cardiac resynchronization therapy using His bundle pacing

Coluccia¹,

Vitale²,

Corallo³

et al. 2020

Cardiovasc electrophysiol

View full text Add to dashboard Cite

show abstract

“…There are no large‐scale randomized clinical studies which determine whether long term outcomes of selective or nonselective HBP differ although small scale studies suggest an equivalent hemodynamic benefit . In an observational study of 640 patients followed over a mean of 2.8 ± 1.8 years there was no difference in outcome in terms of death and heart failure hospitalizations between selective and nonselective HBP . Although s‐HBP may be the ideal it proves a difficult end point in some cases.…”

Section: His Bundle Pacingmentioning

confidence: 99%

“…80,84 In an observational study of 640 patients followed over a mean of 2.8 ± 1.8 years there was no difference in outcome in terms of death and heart failure hospitalizations between selective and nonselective HBP. 87 Although s-HBP may be the ideal it proves a difficult end point in some cases.…”

Section: His Bundle Pacingmentioning

confidence: 99%

The desire for physiological pacing: Are we there yet?

Kaye

2019

Cardiovasc electrophysiol

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Pacing is a well established therapy for bradycardia support and certain types of heart failure. Despite technological advances the optimal pacing lead position remains controversial. Right ventricular pacing, particularly apical has been the site of choice but the induction of abnormal cardiac depolarization and the recognition of an increased risk of impairment of left ventricular systolic function, heart failure and mortality has driven a desire for a true physiological pacing system. A number of different lead positions have been determined and of these His bundle pacing appears to most closely mimic normal ventricular conduction. This article reviews the background to the development of physiological pacing, evaluates historical data for right ventricular pacing and the basis for change and new lead positions.

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