Outcomes of His-bundle pacing upgrade after long-term right ventricular pacing and/or pacing-induced cardiomyopathy: Insights into disease progression

Vijayaraman, Pugazhendhi; Herweg, Bengt; Dandamudi, Gopi; Mittal, Suneet; Bhatt, Advay G.; Marcantoni, Lina; Naperkowski, Angela; Sharma, Parikshit S.; Zanon, Francesco

doi:10.1016/j.hrthm.2019.03.026

Cited by 91 publications

(94 citation statements)

References 19 publications

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“…Furthermore, we Permanent HBP has been performed for two decades in patients undergoing AV-node ablation, [23][24][25] in patients with narrow QRS and normal His-Purkinje conduction, 26,27 and in those with bundle branch block and complete nodal and infranodal block. [28][29][30] However, its adoption in patients with heart failure who are candidates for CRT has emerged only in recent years.…”

Section: Discussionmentioning

confidence: 99%

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: 99%

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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“…In this scenario, physiological pacing appears as a reasonable pacing modality for preventing pacing‐induced cardiomyopathy. In fact, the beneficial effects of HBP in chronically paced patients with LVEF < 50% have been already demonstrated by several studies 14,15 and should be applicable to patients post‐TAVR.…”

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confidence: 86%

The search for physiologic pacing post‐TAVR

Cano

Vijayaraman

2020

Cardiovasc electrophysiol

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“…A patient with rapid reversal of PICM was reported following the institution of His bundle pacing . Subsequently, the feasibility and impact of HBP were reported in 85 patients with chronic RV pacing and longstanding AV block . HBP was successful in 79 (93%) patients.…”

Section: Prevention Of Pacing‐induced Cardiomyopathymentioning

confidence: 99%

Pacing induced cardiomyopathy

Merchant

Mittal

2019

Cardiovasc electrophysiol

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Pacing induced cardiomyopathy (PICM) is most commonly defined as a drop in left ventricle ejection fraction (LVEF) in the setting of chronic, high burden right ventricle (RV) pacing. Recent data suggest, however, that some individuals may experience the onset of heart failure symptoms more acutely after pacemaker implantation.Definitions of PICM which emphasize drop in LVEF may underestimate the incidence of deleterious effects from RV pacing. Treatment of PICM has primarily focused on upgrade to cardiac resynchronization therapy (CRT) when LVEF has dropped.However, emerging data suggest that conduction system pacing (CSP) may offer an opportunity to prevent PICM in the first place.cardiac resynchronization therapy, cardiomyopathy, conduction system pacing, device upgrade, dyssynchrony, his bundle pacing, left bundle branch block, pacemaker

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Outcomes of His-bundle pacing upgrade after long-term right ventricular pacing and/or pacing-induced cardiomyopathy: Insights into disease progression

Cited by 91 publications

References 19 publications

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

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

The search for physiologic pacing post‐TAVR

Pacing induced cardiomyopathy

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