His Bundle Pacing Or Biventricular Pacing For Cardiac Resynchronization Therapy In Heart Failure: Discovering New Methods For An Old Problem

Sharma, Parikshit S.; Vijayaraman, Pugazhendhi

doi:10.4022/jafib.1501

Cited by 17 publications

(18 citation statements)

References 27 publications

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“…8,9 Recent reports have demonstrated a high degree of success in bypassing intra-and infrahisian conduction block, including left bundle branch block (LBBB) with a pacemaker lead. [10][11][12][13][14] Moreover, patients with a pacemaker indication have shown improved clinical response and greater 5-year survival with PHBP compared to right ventricular (RV) pacing. 15 In patients with heart failure and LBBB, PHBP has been shown to achieve cardiac resynchronization therapy (CRT), 11,[16][17][18][19][20][21] and some investigators have suggested PHBP as first-line therapy.…”

Section: Introductionmentioning

confidence: 99%

Permanent His-bundle pacing using stylet-directed, active-fixation leads placed via coronary sinus sheaths compared to conventional lumen-less system

et al. 2019

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BACKGROUND The use of coronary sinus (CS) sheaths to deliver stylet-driven leads (SDLs) for His-bundle pacing (HBP) has not been described. Conventionally, HBP is achieved using a styletless lead delivered through a customized catheter. OBJECTIVE The purpose of this study was to characterize the acute and early-term HBP experience with stylet-driven, active-fixation leads delivered through CS sheaths compared to the conventional approach. METHODS Delivery of Medtronic 4471 and 7742 SDLs was attempted in 27 patients. Delivery was facilitated using CS guide catheters and custom-shaped stylets. Procedural characteristics and lead performance were compared to those of a group of 17 patients in whom delivery of 3830 lumen-less leads (LLLs) was attempted. Patients had heterogeneous pacing indications. RESULTS HBP with SDL was successful in 24 of 27 patients(89%) compared to 15 of 17 patients (88%) in the LLL group. Mean procedural and fluoroscopy times in the SDL and LLL groups were 129 6 43 minutes vs 104 6 43 minutes and 9.6 6 5.2 minutes vs 8.3 6 5.0 minutes, respectively (both P 5 NS). There was a significant difference in procedure and fluoroscopy times within the SDL group between the first and second halves of the series, probably secondary to a learning curve. Acute HBP thresholds were higher with SDL than with LLL (2.6 6 1.5 V vs 1.5 6 1.2 V; P 5 .02) and remained stable at 8.4 6 5.3 months. Both SDLs exhibited similar pacing thresholds. Two crossovers between groups occurred (1 in each group). Four patients with SDL and 1 patient with LLL exhibited high thresholds during follow-up. CONCLUSION Permanent HBP using stylet-driven, active-fixation leads delivered through conventional CS sheaths is feasible. Procedural characteristics and lead performance were clinically acceptable.

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Section: Introductionmentioning

confidence: 99%

Permanent His-bundle pacing using stylet-directed, active-fixation leads placed via coronary sinus sheaths compared to conventional lumen-less system

et al. 2019

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“…Additionally, the capture thresholds have been shown to be stable over long-term allaying the concerns about quicker battery depletion due to higher followup thresholds [31,32]. Similarly, procedure and luoroscopy times have improved over time, consistent with the learning curve of adopting a new technique and can be comparable with implantation of traditional right ventricular pacing leads [19,33,34].…”

Section: Procedural Characteristics Of Hbp Compared With Biventriculamentioning

confidence: 82%

“…The physiologic bene it of PHBP is the ability to utilize intrinsic His-purkinje system to stimulate the ventricles resulting in synchronous and a more physiologic electrical and mechanical activation. Additionally, PHBP can be used as a bail-out strategy in cases patients with limitations of coronary venous anatomy for LV lead placement providing [19].…”

Section: Heart Failure and His Bundlementioning

confidence: 99%

“…PHBP could also be attempted in patients who fail LV lead placement prior to considering surgical epicardial or endocardial LV lead placement. Additionally, HBP may also be considered in patients with cardiomyopathy and underlying RBBB with or without prolonged PR intervals as an option for cardiac resynchronization therapy [19,35]. It remains to be determined if the etiology of cardiomyopathy (ischemic versus nonischemic) play any role in success of CRT with PHBP.…”

Section: Role In Current Therapymentioning

confidence: 99%

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His bundle pacing in heart failure: A review of current literature

Chaudhary¹,

Garg²

2020

J Cardiol Cardiovasc Med

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Biventricular (BiV) pacing revolutionized the heart failure management in patients with sinus rhythm and left bundle branch block; however, left ventricular-lead placement is not always technically possible. Also, BiV pacing does not fully normalize ventricular activation and, therefore, the ventricular resynchronization is imperfect. On the other hand, right ventricular pacing for bradycardia may cause or worsen heart failure in some patients by causing dyssynchronous ventricular activation. His bundle pacing comes as an alternative to current approaches as it activates the ventricles via the native His-Purkinje system, resulting in true physiological pacing, and, therefore, is a promising site for pacing in bradycardia and traditional CRT indications in cases where it can overcome left bundle branch block. Furthermore, it has the potential to open up new indications for pacing therapy in heart failure, such as targeting patients with PR prolongation, but a narrow QRS duration. In this article we explore the history, clinical evidence, proposed mechanisms, procedural characteristics, and the role in current therapy of His bundle pacing in the prevention and treatment of heart failure.

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“…At present, permanent His-bundle pacing is a feasible alternative for patients in whom BiV pacing provided no clinical response. His-bundle pacing allows for the recruitment of BBB disease and ventricular activation in a more physiological fashion, specifically in patients with right BBB and those with AV block [86]. …”

Section: Lead Placementmentioning

confidence: 99%

Cardiac Resynchronization Therapy Optimization: A Comprehensive Approach

et al. 2019

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Since the first report on biventricular pacing in 1994, cardiac resynchronization therapy (CRT) has become standard for patients with advanced heart failure (HF) and ventricular conduction delay. CRT improves myocardial function by resynchronizing myocardial contraction, which results in reverse left ventricular remodeling and improves symptoms and clinical outcomes. Despite the accelerated development of CRT device technology and its increased application in treating HF patients, almost one-third of these patients do not respond to the therapy or gain any clinical benefit from device implantation. Over the last decade, multiple cardiac imaging modalities have provided a deeper understanding of myocardial pathophysiology, thereby improving HF treatment management. However, the optimal strategy for improving the CRT response remains debatable. This article provides an updated overview of the electropathophysiology of myocardial dysfunction in ventricular conduction delay and the diagnostic approaches involving the use of multiple modalities.

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His Bundle Pacing Or Biventricular Pacing For Cardiac Resynchronization Therapy In Heart Failure: Discovering New Methods For An Old Problem

Cited by 17 publications

References 27 publications

Permanent His-bundle pacing using stylet-directed, active-fixation leads placed via coronary sinus sheaths compared to conventional lumen-less system

Permanent His-bundle pacing using stylet-directed, active-fixation leads placed via coronary sinus sheaths compared to conventional lumen-less system

His bundle pacing in heart failure: A review of current literature

Cardiac Resynchronization Therapy Optimization: A Comprehensive Approach

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