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Baroni M, Preda A, Varrenti M, Vargiu S, Carbonaro M, Giordano F, Gigli L, Mazzone P. Left Bundle Branch Area Pacing over His Bundle Pacing: How Far Have We Come? J Clin Med 2023; 12:jcm12093251. [PMID: 37176691 PMCID: PMC10179456 DOI: 10.3390/jcm12093251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 04/25/2023] [Indexed: 05/15/2023] Open
Abstract
Implantable cardiac pacemakers have greatly evolved during the few past years, focusing on newer modalities of physiologic cardiac pacing [...].
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Affiliation(s)
- Matteo Baroni
- Cardio-Thoraco-Vascular Department, Electrophysiology Unit, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy
| | - Alberto Preda
- Cardio-Thoraco-Vascular Department, Electrophysiology Unit, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy
| | - Marisa Varrenti
- Cardio-Thoraco-Vascular Department, Electrophysiology Unit, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy
| | - Sara Vargiu
- Cardio-Thoraco-Vascular Department, Electrophysiology Unit, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy
| | - Marco Carbonaro
- Cardio-Thoraco-Vascular Department, Electrophysiology Unit, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy
| | - Federica Giordano
- Cardio-Thoraco-Vascular Department, Electrophysiology Unit, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy
| | - Lorenzo Gigli
- Cardio-Thoraco-Vascular Department, Electrophysiology Unit, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy
| | - Patrizio Mazzone
- Cardio-Thoraco-Vascular Department, Electrophysiology Unit, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy
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2
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Adverse effects of right ventricular pacing on cardiac function: prevalence, prevention and treatment with physiologic pacing. Trends Cardiovasc Med 2023; 33:109-122. [PMID: 34742888 DOI: 10.1016/j.tcm.2021.10.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 10/24/2021] [Accepted: 10/30/2021] [Indexed: 02/07/2023]
Abstract
Right ventricular (RV) pacing is the main treatment modality for patients with advanced atrioventricular (AV) block. Chronic RV pacing can cause cardiac systolic dysfunction and heart failure (HF). In this review, we discuss studies that have shown deleterious effects of chronic RV pacing on systolic cardiac function causing pacing-induced cardiomyopathy (PiCM), heart failure (HF), HF hospitalization, atrial fibrillation (AF) and cardiac mortality. RV apical pacing is the most widely used and studied. Adverse effects of RV pacing appear to be directly related to pacing burden and are worse in patients with pre-existing left ventricular (LV) dysfunction. Chronic RV pacing is also associated with heart failure with preserved ejection fraction (HFpEF). Mechanisms, risk factors, clinical and echocardiographic features, and strategies to minimize RV pacing-induced cardiac dysfunction are discussed in light of the latest data. Studies on biventricular (Bi-V) pacing upgrade in patients who develop RV PiCM, use of alternate RV pacing sites, de novo Bi-V pacing, and physiologic pacing using HIS bundle pacing (HBP) and left bundle area (LBBA) pacing in patients with an anticipated high RV pacing burden are discussed.
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3
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Tun HN, Khan H, Chernikova D, Mareev Y, Chakrabarti S, Thant M, Cannata A. Conduction system pacing: promoting the physiology to prevent heart failure. Heart Fail Rev 2023; 28:379-386. [PMID: 36781809 PMCID: PMC9941252 DOI: 10.1007/s10741-023-10296-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/24/2023] [Indexed: 02/15/2023]
Abstract
Cardiac conduction system pacing provides physiological ventricular activation by directly stimulating the conduction system. This review describes the two types of conduction system pacing: His bundle pacing (HBP) and left bundle area pacing (LBAP). The most significant advantage of HB pacing is that it can provide a regular, narrow QRS; however, the disadvantages are challenging implantation and a high risk of re-intervention due to lead dislodgement and the development of high pacing threshold. LBAP provides optimum physiological activation of the left ventricle by engaging the left bundle/fascicular fibers. LBAP is more physiological than traditional RV apical pacing and could be an attractive alternative to conventional cardiac resynchronization therapy (CRT). The advantages of LBAP are a relatively more straightforward implantation technique than HBP, better lead stability and pacing thresholds. HBP and LBAP are more physiological than right ventricular pacing and may be used instead of conventional pacemakers. Both HBP and LBBP are being investigated as alternatives to conventional CRT.
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Affiliation(s)
- Han Naung Tun
- grid.59062.380000 0004 1936 7689UVM Medical Centre, Larner College of Medicine, University of Vermont, Given Medical Bldg, E-126, 89 Beaumont Ave, Burlington, VT 05405 USA
| | - Hafiza Khan
- grid.414450.00000 0004 0441 3670Cardiac Electrophysiology, Baylor Scott & White The Heart Hospital, TX Plano, USA
| | - Daryna Chernikova
- Cardiology Department, City Hospital, Heroiv Ukrainy, 17 Street, 84300 Kramatorsk Donetsk, Ukraine
| | - Yury Mareev
- Department of Cardiology, National Medical Research Centre for Therapy and Preventive Medicine, Moscow, Russia ,grid.8756.c0000 0001 2193 314XRobertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - Santabhanu Chakrabarti
- grid.17091.3e0000 0001 2288 9830Division of Cardiology, Department of Medicine, University of British Columbia, Heart Rhythm Services, 211-1033 Davie Street, Vancouver, BC V4N 0J9, Canada
| | - May Thant
- grid.418395.20000 0004 1756 4670Royal Blackburn Hospital, Health Education England, Northwestern Deanery, Haslingden Rd, Blackburn, BB2 3HH UK
| | - Antonio Cannata
- Department of Cardiovascular Sciences, Faculty of Life Sciences & Medicine, King's College - London, London, UK.
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Chen Z, Zhou X, Ma X, Chen K. Recruitment of the cardiac conduction system for optimal resynchronization therapy in failing heart. Front Physiol 2022; 13:1045740. [PMID: 36589433 PMCID: PMC9798297 DOI: 10.3389/fphys.2022.1045740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 12/02/2022] [Indexed: 12/24/2022] Open
Abstract
Heart failure (HF) is a leading health burden around the world. Although pharmacological development has dramatically advanced medication therapy in the field, hemodynamic disorders or mechanical desynchrony deteriorated by intra or interventricular conduction abnormalities remains a critical target beyond the scope of pharmacotherapy. In the past 2 decades, nonpharmacologic treatment for heart failure, such as cardiac resynchronization therapy (CRT) via biventricular pacing (BVP), has been playing an important role in improving the prognosis of heart failure. However, the response rate of BVP-CRT is variable, leaving one-third of patients not benefiting from the therapy as expected. Considering the non-physiological activation pattern of BVP-CRT, more efforts have been made to optimize resynchronization. The most extensively investigated approach is by stimulating the native conduction system, e.g., His-Purkinje conduction system pacing (CSP), including His bundle pacing (HBP) and left bundle branch area pacing (LBBAP). These emerging CRT approaches provide an alternative to traditional BVP-CRT, with multiple proof-of-concept studies indicating the safety and efficacy of its utilization in dyssynchronous heart failure. In this review, we summarize the mechanisms of dyssynchronous HF mediated by conduction disturbance, the rationale and acute effect of CSP for CRT, the recent advancement in clinical research, and possible future directions of CSP.
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Affiliation(s)
- Zhongli Chen
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | | | - Xuan Ma
- Department of Magnetic Resonance Imaging, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Keping Chen
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China,*Correspondence: Keping Chen,
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5
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Conduction System Pacing Today and Tomorrow. J Clin Med 2022; 11:jcm11247258. [PMID: 36555877 PMCID: PMC9780948 DOI: 10.3390/jcm11247258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 11/29/2022] [Accepted: 12/05/2022] [Indexed: 12/12/2022] Open
Abstract
Conduction system pacing (CSP) encompassing His bundle (HBP) and left bundle branch area pacing (LBBAP) is gaining increasing attention in the electrophysiology community. These relatively novel physiological pacing modalities have the potential to outperform conventional pacing approaches with respect to clinical endpoints, although data are currently still limited. While HBP represents the most physiological form of cardiac stimulation, success rates, bundle branch correction, and electrical lead performance over time remain a concern. LBBAP systems may overcome these limitations. In this review article, we provide a comprehensive overview of the current evidence, implantation technique, device programming, and follow-up considerations concerning CSP systems. Moreover, we discuss ongoing technical developments and future perspectives of CSP.
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Three-Dimensional Electro-Anatomical Mapping and Myocardial Work Performance during Spontaneous Rhythm, His Bundle Pacing and Right Ventricular Pacing: The EMPATHY Study. J Cardiovasc Dev Dis 2022; 9:jcdd9110377. [PMID: 36354776 PMCID: PMC9698308 DOI: 10.3390/jcdd9110377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 10/21/2022] [Accepted: 10/29/2022] [Indexed: 11/06/2022] Open
Abstract
Background. His bundle pacing (HBP) has emerged as an alternative site to right ventricular pacing (RVP) with encouraging outcomes. To date, no study has investigated the systematic approach of three-dimensional electroanatomic mapping (3D-EAM) to guide HBP implantation and to evaluate myocardial activation timing. Furthermore, studies reporting a comprehensive assessment of the ventricular function, using myocardial work (MW) evaluation are lacking. Objectives. (1) To evaluate the systematic use of the 3D-EAM as a guide to HBP; (2) to assess the electrical and mechanical activations with high-density mapping, comparing spontaneous ventricular activation (SVA), HBP and RVP; (3) to assess the myocardial function through speckle-tracking echocardiography (STE) and MW analysis in SVA, HBP and RVP. Methods. 3D-EAM was performed in consecutive patients undergoing HBP implantation with a low use of fluoroscopy. All patients were systematically evaluated with high-density mapping, MW and STE. Results. Fifteen patients were enrolled, of whom three had an implant failure (20%). RV activation time was not statistically different between SVA and HBP (103 vs. 104 ms, p = 0.969) but was significantly higher in RVP (133 ms, p = 0.011 vs. SVA and p = 0.001 vs HBP). Global constructive work was significantly lower during RVP (1191 mmHg%) than during SVA and HBP (1648 and 1505 mmHg%, p = 0.011 and p = 0.008, respectively) and did not differ between SVA and HBP (p = 0.075). Conclusions. 3D-EAM and MW evaluation showed that HBP was comparable to the physiological SVA in terms of activation time and cardiac performance. Compared to both SVA and HBP, RVP was associated with a worse activation timing and ventricular efficiency.
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Hoyt RH, Kelley BP, Harry MJ, Marcus RH. Hemodynamic Doppler echocardiographic evaluation of permanent His bundle and biventricular pacing after AV nodal ablation. IJC HEART & VASCULATURE 2022; 42:101102. [PMID: 36161234 PMCID: PMC9493057 DOI: 10.1016/j.ijcha.2022.101102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 07/19/2022] [Accepted: 08/05/2022] [Indexed: 12/01/2022]
Abstract
placing after atrioventricular (AV) nodal ablation for permanent atrial fibrillation (AF) may include cardiac resynchronization therapy (CRT) with either His bundle pacing (HBP) or biventricular pacing (BVP), or conventional single site right ventricular apical pacing (RVAP). To determine the relationship between pacing method and hemodynamic outcome, we used Doppler echocardiographic methods to evaluate left ventricular (LV) hemodynamics after AV nodal ablation and either HBP, BVP, or RVAP. Method 20 patients were evaluated > 6 months after AV nodal ablation, 10 each with chronic HBP or BVP, and all with RVAP lead. Doppler echocardiography was used to measure 3 parameters indicative of CRT: 1) LV dP/dt, 2) the LV pre-ejection interval, and 3) myocardial performance index, relative to intra-patient RVAP. Results Primary endpoint of LV dP/dt on average improved by > 17% with both HBP and BVP, compared to RVAP. HBP but not BVP, had improvement across all three parameters. Conclusion HBP provides LV electromechanical synchrony across multiple echo Doppler parameters. Both HBP and BVP were hemodynamically superior to RVAP following AV nodal ablation.
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Affiliation(s)
- Robert H Hoyt
- Iowa Heart Center, West Des Moines, Iowa. Dr. Kelley is affiliated with Des Moines University of Osteopathic Medicine, Iowa
| | - Brian P Kelley
- Iowa Heart Center, West Des Moines, Iowa. Dr. Kelley is affiliated with Des Moines University of Osteopathic Medicine, Iowa
| | - Mark J Harry
- Iowa Heart Center, West Des Moines, Iowa. Dr. Kelley is affiliated with Des Moines University of Osteopathic Medicine, Iowa
| | - Richard H Marcus
- Iowa Heart Center, West Des Moines, Iowa. Dr. Kelley is affiliated with Des Moines University of Osteopathic Medicine, Iowa
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Zanon F, Marcantoni L, Centioni M, Pastore G, Baracca E. His Bundle Pacing: My Experience, Tricks, and Tips. Card Electrophysiol Clin 2022; 14:141-149. [PMID: 35715073 DOI: 10.1016/j.ccep.2021.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
His Bundle Pacing (HBP) is a form of physiologic pacing achieved through implantation of a pacing electrode into the His bundle. HBP began 20 years ago without any dedicated tools. As specific tools became available HBP quickly spread and proved to be a viable alternative to traditional right ventricle pacing. HBP is reliable and effective in preserving the physiologic ventricular synchrony with clinical benefits particularly evident when a high percentage of pacing is required. Unipolar signals from the lead tip guide the implant. 3D electroanatomical mapping could further assist the procedure.
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Affiliation(s)
- Francesco Zanon
- Arrhythmia and Electrophysiology Unit, Division of Cardiology, Department of Specialistic Medicine, Santa Maria Della Misericordia General Hospital, Viale Tre Martiri 177, 45100 Rovigo, Italy.
| | - Lina Marcantoni
- Arrhythmia and Electrophysiology Unit, Division of Cardiology, Department of Specialistic Medicine, Santa Maria Della Misericordia General Hospital, Viale Tre Martiri 177, 45100 Rovigo, Italy. https://twitter.com/@LinaMarcantoni
| | - Marco Centioni
- Arrhythmia and Electrophysiology Unit, Division of Cardiology, Department of Specialistic Medicine, Santa Maria Della Misericordia General Hospital, Viale Tre Martiri 177, 45100 Rovigo, Italy
| | - Gianni Pastore
- Arrhythmia and Electrophysiology Unit, Division of Cardiology, Department of Specialistic Medicine, Santa Maria Della Misericordia General Hospital, Viale Tre Martiri 177, 45100 Rovigo, Italy
| | - Enrico Baracca
- Arrhythmia and Electrophysiology Unit, Division of Cardiology, Department of Specialistic Medicine, Santa Maria Della Misericordia General Hospital, Viale Tre Martiri 177, 45100 Rovigo, Italy
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Reduction of fluoroscopy in conduction system pacing guided by electroanatomical mapping in pediatrics and congenital heart disease. Indian Pacing Electrophysiol J 2022; 22:182-185. [PMID: 35447346 PMCID: PMC9263654 DOI: 10.1016/j.ipej.2022.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 04/02/2022] [Accepted: 04/15/2022] [Indexed: 10/29/2022] Open
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His Bundle Pacing: A promising alternative strategy for Antibradycardic-pacing. Report of a single center-experience. Hellenic J Cardiol 2021; 64:77-86. [PMID: 34843996 DOI: 10.1016/j.hjc.2021.10.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 07/26/2021] [Accepted: 10/07/2021] [Indexed: 11/21/2022] Open
Abstract
His Bundle Pacing (HBP) is proven to be a safe and effective alternative pacing modality that, in addition, avoids Pacemaker-induced Cardiomyopathy (PICM) by achieving a ''physiological'' ventricular stimulation, via the native conduction system. Indications include various causes of bradycardia requiring antibradycardic pacing, inadequately controlled Atrial Fibrillation requiring AV node ablation and established PICM. In addition, HBP may also be used as an alternative therapy for patients with Heart Failure (HF) and an indication for Cardiac Resynchronization Therapy. Available data show a benefit from HBP with regard to preservation or restoration of intra- and inter-ventricular synchronization, improvement in Left Ventricular Ejection Fraction, functional status and Quality of Life, decrease in atrial fibrillation incidence and improvement in HF hospitalization rates, compared to conventional pacing. Nevertheless, superiority in terms of mortality rates has not been consistently demonstrated and long-term efficacy and safety remains to be proven. In the present manuscript, we review the status of HBP and we present our current experience with this novel pacing modality.
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11
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[His bundle and left bundle branch pacing]. Herz 2021; 46:499-512. [PMID: 34766195 DOI: 10.1007/s00059-021-05080-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2021] [Indexed: 10/19/2022]
Abstract
Cardiac pacemakers are an extremely effective treatment for bradycardia but can, however, cause desynchronization of ventricular contraction leading to cardiomyopathy. Pacing of the conduction system can prevent and even reverse desynchronization, which is impressively visible in echocardiography with speckle tracing. His' bundle and left bundle branch pacing requires a specific implantation technique, sheaths and leads which can achieve successful stimulation of the conduction system in up to 98% of cases. Data on conduction system pacing have been acquired in numerous studies but only a few randomized outcome studies. Therefore, in the current European guidelines His' bundle and left bundle branch pacing only have a low level recommendation. The guidelines recommend His' bundle pacing in patients in whom a coronary sinus lead cannot be implanted and in patients with permanent atrial fibrillation and planned atrioventricular (AV) node ablation for heart rate control. Additionally, conduction system pacing appears to be meaningful in patients with an AV block who require pacing of the ventricle for ≥20% of the time or who already show a slightly or moderately reduced left ventricular ejection fraction (36-50%). Even in patients scheduled for generator replacement who have developed a cardiac pacemaker-induced cardiomyopathy, the opportunity should not be missed to upgrade the system by implantation of a His' bundle electrode.
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Peng X, Chen Y, Wang X, Hu A, Li X. Safety and efficacy of His-bundle pacing/left bundle branch area pacing versus right ventricular pacing: a systematic review and meta-analysis. J Interv Card Electrophysiol 2021; 62:445-459. [PMID: 34019186 DOI: 10.1007/s10840-021-00998-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 04/15/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Recent studies have demonstrated that right ventricular pacing (RVP) has deleterious effects on non-synchronized ventricular contraction, while His-bundle pacing (HBP) or left bundle branch area pacing (LBBaP) contribute to improvements in patients' mid- and long-term outcomes. This meta-analysis aimed to compare the safety and efficacy of physiologic pacing (HBP/LBBaP) versus those of RVP. METHODS A systematic search of PubMed, Cochrane Library, and Embase was conducted for studies that compared the effects of physiologic pacing and RVP. All eligible studies were published before January 1, 2021 and were conducted in humans. STATA software version 15.0 was used for all the data analyses. RESULTS Twenty articles (n = 2787 patients) were included in this meta-analysis. Compared to RVP, physiologic pacing was associated with a significantly shorter QRS duration and better cardiac function. Physiologic pacing was also correlated with lower rates of mitral regurgitation, pacing-induced cardiomyopathy, death, heart failure hospitalization, and atrial fibrillation, although the above results were not statistically significant. In addition, RVP led to the achievement of higher success rates than physiologic pacing, a shorter fluoroscopic time and mean procedure duration, a lower pacing threshold: the results were statistically significant. Compared with HBP, LBBaP appeared to have some advantages in R wave amplitudes, pacing threshold, fluoroscopic time, procedure time, and success rate, with statistically significant differences. Whereas HBP was associated with fewer surgical complications and shorter QRS duration, the results were not statistically significant. CONCLUSION Physiologic pacing (HBP/LBBaP) might be a better strategy than RVP and improve long-term clinical outcomes like cardiac function. Although LBBaP appears to have some advantages over HBP, the long-term benefits are still controversial. More large-scale randomized clinical trials are needed for further verification.
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Affiliation(s)
- Xinyi Peng
- Heart Center, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Yu Chen
- Heart Center, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Xiaofei Wang
- Department of Cardiology, Qindao University Medical College Affiliated Yantaiyuhuangding Hospital, Yantai, China
| | - Aizhen Hu
- Department of Cardiology, Qindao University Medical College Affiliated Yantaiyuhuangding Hospital, Yantai, China
| | - Xuexun Li
- Department of Cardiology, Shandong Provincial Hospital, Shandong, 250021, Jinan, China.
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Bednarek A, Ionita O, Moskal P, Linkova H, Kiełbasa G, Prochazkova R, Vesela J, Rajzer M, Curila K, Jastrzębski M. Nonselective versus selective His bundle pacing: An acute intrapatient speckle‐tracking strain echocardiographic study. J Cardiovasc Electrophysiol 2020; 32:117-125. [DOI: 10.1111/jce.14834] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 10/26/2020] [Accepted: 11/09/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Agnieszka Bednarek
- First Department of Cardiology, Interventional Electrocardiology, and Hypertension Jagiellonian University Medical College Kraków Poland
| | - Oana Ionita
- Cardiocenter, Department of Cardiology 3rd Medical Faculty of Charles University in Prague Prague Czech Republic
| | - Paweł Moskal
- First Department of Cardiology, Interventional Electrocardiology, and Hypertension Jagiellonian University Medical College Kraków Poland
| | - Hana Linkova
- Cardiocenter, Department of Cardiology 3rd Medical Faculty of Charles University in Prague Prague Czech Republic
| | - Grzegorz Kiełbasa
- First Department of Cardiology, Interventional Electrocardiology, and Hypertension Jagiellonian University Medical College Kraków Poland
| | - Radka Prochazkova
- Cardiocenter, Department of Cardiology 3rd Medical Faculty of Charles University in Prague Prague Czech Republic
| | - Jana Vesela
- Cardiocenter, Department of Cardiology 3rd Medical Faculty of Charles University in Prague Prague Czech Republic
| | - Marek Rajzer
- First Department of Cardiology, Interventional Electrocardiology, and Hypertension Jagiellonian University Medical College Kraków Poland
| | - Karol Curila
- Cardiocenter, Department of Cardiology 3rd Medical Faculty of Charles University in Prague Prague Czech Republic
| | - Marek Jastrzębski
- First Department of Cardiology, Interventional Electrocardiology, and Hypertension Jagiellonian University Medical College Kraków Poland
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Lakhani I, Gong M, Wong CW, Bazoukis G, Letsas KP, Li G, Wahleed KB, Xia Y, Baranchuk A, Tse G, Leung KSK, Liu T, Chang D, International Health Informatics Study (IHIS). Does Minimizing Ventricular Pacing Reduce the Incidence of Atrial Fibrillation? A Systematic Review and Meta-analysis of Randomized Controlled Trials. CARDIOVASCULAR INNOVATIONS AND APPLICATIONS 2020. [DOI: 10.15212/cvia.2019.0586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background: Right ventricular pacing disrupts atrioventricular synchrony and increases the risk of atrial fibrillation (AF). However, whether algorithms for minimizing ventricular pacing reduce the incidence of AF remains controversial. Therefore, we conducted a systematic review
and meta-analysis to compare the incidence of AF between minimizing ventricular pacing and conventional pacing protocols in patients with pacemakers implanted.Methods: The PubMed, Embase, and Cochrane Library databases were searched up to August 1, 2017, for randomized controlled
trials that reported the incidence of AF in patients with and without the use of algorithms for minimizing ventricular pacing.Results: Eleven studies comprising 5705 participants (61% males, mean age 71 years [standard deviation 11 years]) were finally included in the analysis.
The mean follow-up duration was 24 months. Use of algorithms for minimizing ventricular pacing significantly reduced the incidence of AF, with an odds ratio of 0.74 (95% confidence interval 0.55‐1.00; P<0.05). There was moderate heterogeneity among studies (I2=63%).Conclusions:
The incidence of AF was reduced by 26% with use of algorithms for minimizing ventricular pacing. The incorporation of such algorithms in routine clinical practice should in theory lead to a decrease in AF-related morbidity and mortality.
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Affiliation(s)
- Ishan Lakhani
- Laboratory of Cardiovascular Physiology, Li Ka Shing Institute of Health Sciences, Hong Kong Special Administrative Region, People’s Republic of China
| | - Mengqi Gong
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, People’s Republic of China
| | - Cheuk Wai Wong
- Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Special Administrative Region, People’s Republic of China
| | - George Bazoukis
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, Evangelismos General Hospital of Athens, Athens, Greece
| | - Konstantinos P. Letsas
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, Evangelismos General Hospital of Athens, Athens, Greece
| | - Guangping Li
- Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Special Administrative Region, People’s Republic of China
| | - Khalid bin Wahleed
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Yunlong Xia
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Adrian Baranchuk
- Division of Cardiology, Kingston General Hospital, Queen’s University, Kingston, Ontario, Canada
| | - Gary Tse
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, People’s Republic of China
| | | | - Tong Liu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, People’s Republic of China
| | - Dong Chang
- Xiamen Cardiovascular Hospital, Xiamen University, Xiamen, Fujian, People’s Republic of China
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15
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Israel CW, Tribunyan S, Richter S. [Indications for His bundle and left bundle branch pacing]. Herzschrittmacherther Elektrophysiol 2020; 31:135-143. [PMID: 32385573 DOI: 10.1007/s00399-020-00689-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
His bundle pacing (HBP) allows ventricular excitation through the entire cardiac conduction system, resulting in a better synchronicity and efficacy of contraction compared to myocardial pacing. Due to better, dedicated implantation tools and exact practical implantation recommendations, HBP has developed into a form of stimulation that can be successfully applied with reasonable time and effort in >90% of patients. The rate of lead dislodgement and threshold increase is similar to conventional pacemaker systems. Despite a rather weak data base and a paucity of randomized trials, HBS represents an alternative to conventional right or biventricular pacing in the following conditions: (1) high-degree atrioventricular (AV) block with expected ventricular pacing >20% of the time, (2) AV block 1st degree with long PQ (alone or in combination with intermittent 2nd to 3rd degree AV block or sick sinus syndrome), (3) AV node ablation due to refractory atrial fibrillation, and (4) upgrade in pacing-induced cardiomyopathy. Moreover, HBP may be useful in context with cardiac resynchronization therapy (CRT). Left bundle branch block below the level of His represents a limitation of HBP. Therefore, more recently left bundle branch pacing (LBBP) has been introduced to correct left bundle branch block. LBBP seems to be possible in a wider anatomic area and may be easier to implant. However, LBBP requires active screw-in of the lead deep into the ventricular septum. Experience with this new technique is limited, particularly regarding long-term performance.
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Affiliation(s)
- Carsten W Israel
- Klinik für Innere Medizin - Kardiologie, Diabetologie & Nephrologie, Evangelisches Klinikum Bethel, Burgsteig 13, 33617, Bielefeld, Deutschland.
| | - Sona Tribunyan
- Klinik für Innere Medizin - Kardiologie, Diabetologie & Nephrologie, Evangelisches Klinikum Bethel, Burgsteig 13, 33617, Bielefeld, Deutschland
| | - Sergio Richter
- Abteilung für Elektrophysiologie, Herzzentrum Leipzig und Universität Leipzig, Leipzig, Deutschland
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16
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Lewis AJM, Foley P, Whinnett Z, Keene D, Chandrasekaran B. His Bundle Pacing: A New Strategy for Physiological Ventricular Activation. J Am Heart Assoc 2020; 8:e010972. [PMID: 30854911 PMCID: PMC6475060 DOI: 10.1161/jaha.118.010972] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Andrew J M Lewis
- 1 Department of Cardiology Great Western Hospitals NHS Foundation Trust Swindon United Kingdom.,2 Radcliffe Department of Medicine and British Heart Centre for Research Excellence John Radcliffe Hospital University of Oxford United Kingdom
| | - Paul Foley
- 1 Department of Cardiology Great Western Hospitals NHS Foundation Trust Swindon United Kingdom
| | - Zachary Whinnett
- 3 Imperial College London Hammersmith Hospital London United Kingdom
| | - Daniel Keene
- 3 Imperial College London Hammersmith Hospital London United Kingdom
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17
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Stanley A, Athanasuleas C, Buckberg G. How His bundle pacing prevents and reverses heart failure induced by right ventricular pacing. Heart Fail Rev 2020; 26:1311-1324. [PMID: 32318885 DOI: 10.1007/s10741-020-09962-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Ideal heart performance demands vigorous systolic contractions and rapid diastolic relaxation. These sequential events are precisely timed and interdependent and require the rapid synchronous electrical stimulation provided by the His-Purkinje system. Right ventricular (RV) pacing creates slow asynchronous electrical stimulation that disrupts the timing of the cardiac cycle and results in left ventricular (LV) mechanical asynchrony. Long-term mechanical asynchrony produces LV dysfunction, remodeling, and clinical heart failure. His bundle pacing preserves synchronous electrical and mechanical LV function, prevents or reverses RV pacemaker-induced remodeling, and reduces heart failure.
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Affiliation(s)
- Alfred Stanley
- Cardiovascular Associates of the Southeast, Birmingham, AL, USA
| | - Constantine Athanasuleas
- Division of Cardiothoracic Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Gerald Buckberg
- Division of Cardiac Surgery, Department of Surgery, Cardiovascular Center at UCLA, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
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18
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Curila K, Prochazkova R, Jurak P, Jastrzebski M, Halamek J, Moskal P, Stros P, Vesela J, Waldauf P, Viscor I, Plesinger F, Sussenbek O, Herman D, Osmancik P, Smisek R, Leinveber P, Czarnecka D, Widimsky P. Both selective and nonselective His bundle, but not myocardial, pacing preserve ventricular electrical synchrony assessed by ultra-high-frequency ECG. Heart Rhythm 2020; 17:607-614. [DOI: 10.1016/j.hrthm.2019.11.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Indexed: 10/25/2022]
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19
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His bundle has a shorter chronaxie than does the adjacent ventricular myocardium: Implications for pacemaker programming. Heart Rhythm 2019; 16:1808-1816. [DOI: 10.1016/j.hrthm.2019.06.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Indexed: 11/21/2022]
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20
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Impact of physiologic pacing versus right ventricular pacing among patients with left ventricular ejection fraction greater than 35%: A systematic review for the 2018 ACC/AHA/HRS guideline on the evaluation and management of patients with bradycardia and cardiac conduction delay. Heart Rhythm 2019; 16:e280-e298. [DOI: 10.1016/j.hrthm.2018.10.035] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Indexed: 01/18/2023]
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21
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Slotwiner DJ, Raitt MH, Del-Carpio Munoz F, Mulpuru SK, Nasser N, Peterson PN. Impact of Physiologic Pacing Versus Right Ventricular Pacing Among Patients With Left Ventricular Ejection Fraction Greater Than 35%: A Systematic Review for the 2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay. J Am Coll Cardiol 2019; 74:988-1008. [DOI: 10.1016/j.jacc.2018.10.045] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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22
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Padala SK, Ellenbogen KA. Selective Versus Nonselective His Bundle Pacing. JACC Clin Electrophysiol 2019; 5:775-777. [DOI: 10.1016/j.jacep.2019.05.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 05/30/2019] [Indexed: 11/25/2022]
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Affiliation(s)
- Venkat D. Nagarajan
- Department of Cardiology, Royal Brompton and Harefield Hospital (V.D.N., S.E.), Royal Brompton & Harefield NHS Trust, Imperial College London, United Kingdom
- Department of Cardiology, Doncaster and Bassetlaw Hospitals NHS Foundation Trust, Doncaster, United Kingdom (V.D.N.)
| | - Siew Yen Ho
- Cardiac Morphology, Paediatrics (S.Y.H.), Royal Brompton & Harefield NHS Trust, Imperial College London, United Kingdom
| | - Sabine Ernst
- Department of Cardiology, Royal Brompton and Harefield Hospital (V.D.N., S.E.), Royal Brompton & Harefield NHS Trust, Imperial College London, United Kingdom
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24
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Sato T, Soejima K, Maeda A, Mohri T, Tashiro M, Momose Y, Komeda M, Nonoguchi N, Hoshida K, Miwa Y, Ueda A, Togashi I. Deep Negative Deflection in Unipolar His-Bundle Electrogram as a Predictor of Excellent His-Bundle Pacing Threshold Postimplant. Circ Arrhythm Electrophysiol 2019; 12:e007415. [DOI: 10.1161/circep.119.007415] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Toshiaki Sato
- Division of Advanced Arrhythmia Management (T.S., A.U.), the Second Department of Internal Medicine, Kyorin University School of Medicine, Mitaka, Japan
| | - Kyoko Soejima
- Division of Cardiology (K.S., A.M., T.M., M.T., Y.M., M.K., N.N., K.H., Y.M., I.T.), the Second Department of Internal Medicine, Kyorin University School of Medicine, Mitaka, Japan
| | - Akiko Maeda
- Division of Cardiology (K.S., A.M., T.M., M.T., Y.M., M.K., N.N., K.H., Y.M., I.T.), the Second Department of Internal Medicine, Kyorin University School of Medicine, Mitaka, Japan
| | - Takato Mohri
- Division of Cardiology (K.S., A.M., T.M., M.T., Y.M., M.K., N.N., K.H., Y.M., I.T.), the Second Department of Internal Medicine, Kyorin University School of Medicine, Mitaka, Japan
| | - Mika Tashiro
- Division of Cardiology (K.S., A.M., T.M., M.T., Y.M., M.K., N.N., K.H., Y.M., I.T.), the Second Department of Internal Medicine, Kyorin University School of Medicine, Mitaka, Japan
| | - Yuichi Momose
- Division of Cardiology (K.S., A.M., T.M., M.T., Y.M., M.K., N.N., K.H., Y.M., I.T.), the Second Department of Internal Medicine, Kyorin University School of Medicine, Mitaka, Japan
| | - Michitsugu Komeda
- Division of Cardiology (K.S., A.M., T.M., M.T., Y.M., M.K., N.N., K.H., Y.M., I.T.), the Second Department of Internal Medicine, Kyorin University School of Medicine, Mitaka, Japan
| | - Noriko Nonoguchi
- Division of Cardiology (K.S., A.M., T.M., M.T., Y.M., M.K., N.N., K.H., Y.M., I.T.), the Second Department of Internal Medicine, Kyorin University School of Medicine, Mitaka, Japan
| | - Kyoko Hoshida
- Division of Cardiology (K.S., A.M., T.M., M.T., Y.M., M.K., N.N., K.H., Y.M., I.T.), the Second Department of Internal Medicine, Kyorin University School of Medicine, Mitaka, Japan
| | - Yosuke Miwa
- Division of Cardiology (K.S., A.M., T.M., M.T., Y.M., M.K., N.N., K.H., Y.M., I.T.), the Second Department of Internal Medicine, Kyorin University School of Medicine, Mitaka, Japan
| | - Akiko Ueda
- Division of Advanced Arrhythmia Management (T.S., A.U.), the Second Department of Internal Medicine, Kyorin University School of Medicine, Mitaka, Japan
| | - Ikuko Togashi
- Division of Cardiology (K.S., A.M., T.M., M.T., Y.M., M.K., N.N., K.H., Y.M., I.T.), the Second Department of Internal Medicine, Kyorin University School of Medicine, Mitaka, Japan
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25
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Das A, Chatterjee S. Feasibility of RA-LV pacing in patients with symptomatic left bundle branch block: a pilot study. Heart Vessels 2019; 34:1552-1558. [PMID: 30963301 DOI: 10.1007/s00380-019-01390-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 03/22/2019] [Indexed: 11/29/2022]
Abstract
Several studies have reported the adverse effects of right ventricular apical pacing. Permanent His bundle pacing is proved to be the most physiological. But it can be technically difficult sometimes. One recent large multicenter randomized trial showed that pacing from left ventricular apex or mid-lateral wall has the greatest potential to prevent pacing-induced reduction of cardiac pump function (by maintaining left ventricular mechanical synchrony) and, therefore, can be considered as physiological site. In our study, we have wanted to see the outcome of left ventricular pacing through coronary sinus branch with active fixation bipolar lead as a routine pacing technique in patients with symptomatic left bundle branch block. In our study we have recruited 27 patients for left ventricular pacing through coronary sinus branch (as done in cardiac resynchronization therapy) with active fixation bipolar lead and 33 patients for right ventricular apical pacing (control) and compared left ventricular pacing with right ventricular apical pacing in patients with history of syncope with left bundle branch block in baseline electrocardiography who presented with atrio-ventricular block or prolonged HV interval (≥ 70 ms) on electrophysiology study in term of procedure and fluoroscopy time and short-term lead performance and left ventricular function. The results of our study showed that left ventricular pacing through a tributary of coronary sinus is associated with shortened QRS duration (21.10 ± 3.92 ms) and better LV function (higher left ventricular ejection fraction 64.00 ± 3.03 vs. 59.73 ± 6.73 and lower left ventricular diastolic internal diameter 4.58 ± 0.32 vs. 5.23 ± 0.40 cm) in comparison to right ventricular apical pacing. However, the total procedure time and fluoroscopy time was significantly higher (73.75 ± 11.02 vs. 63.32 ± 6.06 min and 7.08 ± 1.48 vs. 5.02 ± 1.39 min, respectively) in left ventricular pacing group. The results of this study indicate that transvenous left ventricular epicardial pacing may be an option for physiological pacing in patients with symptomatic left bundle branch block.
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Affiliation(s)
- Asit Das
- Department of Cardiology, IPGME&R and SSKM Hospital, Flat-B1, GB-43, Narayantala (west), DB Nagar, Kolkata, West Bengal, 700059, India.
| | - Suman Chatterjee
- Department of Cardiology, IPGME&R and SSKM Hospital, Flat-B1, GB-43, Narayantala (west), DB Nagar, Kolkata, West Bengal, 700059, India
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26
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Moore SKL, Chau KH, Chaudhary S, Rubin G, Bayne J, Avula UMR, Wang DY, Sorbera C, Dizon J, Biviano A, Waase M, Iyer V, George I, Kodali SK, Nazif TM, Garan H, Wan EY. Leadless pacemaker implantation: A feasible and reasonable option in transcatheter heart valve replacement patients. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2019; 42:542-547. [PMID: 30829416 DOI: 10.1111/pace.13648] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 02/08/2019] [Accepted: 02/27/2019] [Indexed: 01/06/2023]
Abstract
BACKGROUND Leadless pacemakers (LPMs) have been shown to have lower postoperative complications than traditional permanent pacemakers but there have been no studies on the outcomes of LPMs in patients with transcatheter heart valve replacements (THVRs). This study determined outcomes of LPMs compared to transvenous single-chamber pacemakers (SCPs) post-THVR. METHODS This is a retrospective single-center study including 10 patients who received LPMs post-THVR between February 2017 and August 2018 and a comparison group of 23 patients who received SCP post-THVR between July 2008 and August 2018. LPM or SCP was implanted at the discretion of electrophysiologists for atrial fibrillation with slow ventricular response or sinus node dysfunction with need for single-chamber pacing only. RESULTS LPMs were associated with decreased tricuspid regurgitation (P = 0.04) and decreased blood loss during implantation (7.5 ± 2.5 cc for LPMs vs 16.8 ± 3.2 cc for SCPs, P = 0.03). Five LPM patients had devices positioned in the right ventricular septum as seen on transthoracic echocardiogram. Frequency of ventricular pacing was similar between LPM and SCP groups. In the LPM group, one case was complicated by a pseudoaneurysm and one death was due to noncardiac causes. There was one pneumothorax and one pocket infection in the SCP group. CONCLUSIONS In this small retrospective study, LPMs were feasible post-THVR and found to perform as well as SCPs, had less intraprocedural blood loss, and were associated with less tricuspid regurgitation. Further, larger studies are required to follow longer-term outcomes and complications.
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Affiliation(s)
- Sarah K L Moore
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Katherine H Chau
- Division of Cardiology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Salma Chaudhary
- Division of Cardiology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Geoffrey Rubin
- Division of Cardiology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Joseph Bayne
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Uma Mahesh R Avula
- Division of Cardiology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Daniel Y Wang
- Division of Cardiology, Montefiore-White Plains Hospital, White Plains, New York
| | - Carmine Sorbera
- Division of Cardiology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Jose Dizon
- Division of Cardiology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Angelo Biviano
- Division of Cardiology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Marc Waase
- Division of Cardiology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Vivek Iyer
- Division of Cardiology, Department of Medicine, Marin General Hospital, Greenbrae, California
| | - Isaac George
- Department of Surgery, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Susheel K Kodali
- Division of Cardiology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Tamim M Nazif
- Division of Cardiology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Hasan Garan
- Division of Cardiology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Elaine Y Wan
- Division of Cardiology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
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27
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Loring Z, Sun AY. Should His Bundle Pacing Be Preferred over Cardiac Resynchronization Therapy Following Atrioventricular Junction Ablation? Cardiol Clin 2019; 37:231-240. [PMID: 30926024 DOI: 10.1016/j.ccl.2019.01.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Atrial fibrillation (AF) and heart failure (HF) are associated with high morbidity and mortality, which is particularly detrimental when patients develop rapid ventricular rates (RVR). Atrioventricular junction (AVJ) ablation with pacemaker implantation has been used as a method of achieving rate control in patients with incessant AF with RVR. Right ventricular only pacing is known to be harmful in the setting of HF. His bundle pacing (HBP) and biventricular (BiV) pacing both offer durable pacing solutions that offer more physiologic activation. This review describes the benefits and drawbacks of HBP and BiV pacing in HF patients after AVJ ablation.
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Affiliation(s)
- Zak Loring
- Division of Cardiology, Section of Electrophysiology, Duke University Medical Center, 2301 Erwin Road, Durham, NC 27710, USA; Duke Clinical Research Institute, 200 Morris St, Durham, NC 27701, USA.
| | - Albert Y Sun
- Division of Cardiology, Section of Electrophysiology, Duke University Medical Center, 2301 Erwin Road, Durham, NC 27710, USA; Division of Cardiology, Section of Electrophysiology, Durham VA Medical Center, 508 Fulton Street, Durham, NC 27705, USA
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28
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Tang J, Chen S, Liu L, Liao H, Zhan X, Wu S, Liang Y, Chen O, Lin C, Zhang Q, Wei H, Chen D. Assessment of Permanent Selective His Bundle Pacing in Left Ventricular Synchronization Using 3-D Speckle Tracking Echocardiography. ULTRASOUND IN MEDICINE & BIOLOGY 2019; 45:385-394. [PMID: 30509784 DOI: 10.1016/j.ultrasmedbio.2018.10.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 09/14/2018] [Accepted: 10/04/2018] [Indexed: 06/09/2023]
Abstract
The study described here aimed to evaluate left ventricular (LV) systolic mechanical synchronization during permanent selective His bundle pacing (SHBP) using 3-D speckle-tracking echocardiography post-operatively and 6 mo after pacemaker implantation in 62 patients randomly assigned to SHBP (n = 32) or right ventricular apical pacing (RVAP, n = 30). A standard apex four-chamber view was exposed and was transformed into full-volume mode under 3-D echocardiography. Three-dimensional speckle-tracking echocardiography was analyzed offline. The primary endpoint was LV mechanical synchronization post-operatively and during the 6-mo follow-up. Significant LV dyssynchrony was detected while evaluating the maximum time difference and standard deviation of 16-segment systolic time to peak 3-D strain at 1 wk and 6 mo. The pacing thresholds were significantly higher in the SHBP than in the RVAP group throughout follow-up. The R-wave amplitude was significantly lower in the SHBP group than with RVAP. The pacing parameters during SHBP were as stable as during conventional RVAP during the mid-term follow-up. In conclusion, 3-D speckle-tracking echocardiography is feasible and provides a more convenient method for evaluating LV synchrony.
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Affiliation(s)
- Jiaojiao Tang
- Department of Cardiology, Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Silin Chen
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Lie Liu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Hongtao Liao
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Xianzhang Zhan
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Shulin Wu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Yuanhong Liang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Oudi Chen
- Department of Echocardiography, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Chunying Lin
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Qianhuan Zhang
- Department of Echocardiography, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Huiqiang Wei
- Department of Echocardiography, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Dongli Chen
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China.
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29
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Sugrue A, Bhatia S, Vaidya VR, Kucuk U, Mulpuru SK, Asirvatham SJ. His Bundle (Conduction System) Pacing: A Contemporary Appraisal. Card Electrophysiol Clin 2019; 10:461-482. [PMID: 30172283 DOI: 10.1016/j.ccep.2018.05.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The His bundle (conduction system) is an attractive target for physiologic pacing because it uses the native conduction system. Although the potential benefits of conduction system pacing were recognized in the 1970s, in the past 2 decades, it has grown in interest as a potentially preferred method of ventricular stimulation in appropriate patients. This review provides an appraisal of conduction system pacing, with focus on anatomy, physiology, tools, and techniques as well as an appraisal of current published data and thoughts on future directions.
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Affiliation(s)
- Alan Sugrue
- Division of Heart Rhythm, Department of Cardiovascular Diseases, Mayo Clinic, 200 1st Street South West, Rochester, MN 55902, USA
| | - Subir Bhatia
- Division of Internal Medicine, Department of Medicine, Mayo Clinic, 200 1st Street South West, Rochester, MN 55902, USA
| | - Vaibhav R Vaidya
- Division of Heart Rhythm, Department of Cardiovascular Diseases, Mayo Clinic, 200 1st Street South West, Rochester, MN 55902, USA
| | - Ugur Kucuk
- Division of Heart Rhythm, Department of Cardiovascular Diseases, Mayo Clinic, 200 1st Street South West, Rochester, MN 55902, USA
| | - Siva K Mulpuru
- Division of Heart Rhythm, Department of Cardiovascular Diseases, Mayo Clinic, 200 1st Street South West, Rochester, MN 55902, USA
| | - Samuel J Asirvatham
- Division of Heart Rhythm, Department of Cardiovascular Diseases, Mayo Clinic, 200 1st Street South West, Rochester, MN 55902, USA.
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Abstract
Long-term right ventricular apical pacing has been associated with detrimental effects, including an increased risk for heart failure, atrial fibrillation, and death. Most of these adverse effects result from ventricular dyssynchrony related to perturbed ventricular depolarization. In addition, biventricular pacing has limited benefits in patients with non-left bundle branch block and severely reduced ejection fraction. Consequently, alternative pacing strategies that mimic natural physiology are desired. Recently, permanent His bundle pacing has emerged as a true physiologic form of ventricular pacing that has been shown to be safe and feasible in clinical practice.
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Affiliation(s)
- Fatima M Ezzeddine
- Indiana University School of Medicine, 1801 North Senate Boulevard, Suite 4000, Indianapolis, IN 46032, USA
| | - Gopi Dandamudi
- Indiana University School of Medicine, 1801 North Senate Boulevard, Suite 4000, Indianapolis, IN 46032, USA.
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31
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Chávez-González E, Barja LD, Ortega DF, Pérez-Rodríguez A. Estimulación eléctrica permanente en región septal en pacientes con insuficiencia cardíaca secundaria a estimulación en ápex de ventrículo derecho. ARCHIVOS DE CARDIOLOGIA DE MEXICO 2018; 88:474-482. [DOI: 10.1016/j.acmx.2018.05.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 05/28/2018] [Accepted: 05/31/2018] [Indexed: 11/26/2022] Open
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32
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Ventricular septal pacing: Optimum method to position the lead. Indian Heart J 2018; 70:713-720. [PMID: 30392512 PMCID: PMC6204444 DOI: 10.1016/j.ihj.2018.01.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 12/18/2017] [Accepted: 01/10/2018] [Indexed: 12/02/2022] Open
Abstract
Adverse hemodynamics of right ventricular (RV) pacing is known for years. Several studies have revealed that adverse outcomes of RV apical pacing are directly linked to cumulative percentage of ventricular pacing. Algorithms to minimize ventricular pacing are only effective if there is good atrioventricular (AV) conduction. A need for an alternate site for ventricular pacing is evident in patients with high presumed ventricular pacing burden. Most studied alternate site for ventricular pacing is ventricular septum (outflow tract septum and mid-septum). Conventionally septal position of the ventricular pacing lead is confirmed by fluoroscopic appearance of the lead and characteristics electrocardiographic (ECG) features. However, several recent studies have challenged these fluoroscopic and ECG features as to be inadequate. So, there is need for a systematic approach for septal positioning of the ventricular lead.
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Slotwiner DJ, Raitt MH, Del-Carpio Munoz F, Mulpuru SK, Nasser N, Peterson PN. Impact of Physiologic Pacing Versus Right Ventricular Pacing Among Patients With Left Ventricular Ejection Fraction Greater Than 35%: A Systematic Review for the 2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Circulation 2018; 140:e483-e503. [PMID: 30586773 DOI: 10.1161/cir.0000000000000629] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND It is unclear whether physiologic pacing by either cardiac biventricular pacing (BiVP) or His bundle pacing (HisBP) may prevent adverse structural and functional consequences known to occur among some patients who receive right ventricular pacing (RVP). AIM Our analysis sought to review existing literature to determine if BiVP and/or HisBP might prevent adverse remodeling and be associated with structural, functional, and clinical advantages compared with RVP among patients without severe left ventricular dysfunction (>35%) who required permanent pacing because of heart block. METHODS A literature search was conducted using MEDLINE (through PubMed) and Embase to identify randomized trials and observational studies comparing the effects of BiVP or HisBP versus RVP on measurements of left ventricular dimensions, left ventricular ejection fraction (LVEF), heart failure functional classification, quality of life, 6-minute walk, hospitalizations, and mortality. Data from studies that met the appropriate population, intervention, comparator, and outcomes of interest were abstracted for meta-analysis. Studies that reported pooled outcomes among patients with LVEF both above and below 35% could not be included in the meta-analysis because of strict relationships with industry procedures that preclude retrieval of industry-retained unpublished data on the subset of patients with preserved left ventricular function. RESULTS Evidence from 8 studies, including a total of 679 patients meeting the prespecified criteria for inclusion, was identified. Results were compared for BiVP versus RVP, HisBP versus RVP, and BiVP+HisBP versus RVP. Among patients who received physiologic pacing with either BiVP or HisBP, the LV end-diastolic and end-systolic volumes were significantly lower (mean duration of follow-up: 1.64 years; -2.77 mL [95% CI -4.37 to -1.1 mL]; P=0.001; and -7.09 mL [95% CI -11.27 to -2.91; P=0.0009) and LVEF remained preserved or increased (mean duration of follow-up: 1.57 years; 5.328% [95% CI: 2.86%-7.8%; P<0.0001). Data on clinical impact such as functional status and quality of life were not definitive. Data on hospitalizations were unavailable. There was no effect on mortality. Several studies stratified results by LVEF and found that patients with LVEF >35% but ≤52% were more likely to receive benefit from physiologic pacing. Patients with chronic atrial fibrillation who underwent atrioventricular node ablation and pacemaker implant demonstrated clear improvement in LVEF with BiVP or HisBP versus RVP. CONCLUSION Among patients with LVEF >35%, the LVEF remained preserved or increased with either BiVP or HisBP compared with RVP. However, patient-centered clinical outcome improvement appears to be limited primarily to patients who have chronic atrial fibrillation with rapid ventricular response rates and have undergone atrioventricular node ablation.
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Ezzeddine FM, Dandamudi G. Updates on His bundle pacing: The road more traveled lately. Trends Cardiovasc Med 2018; 29:326-332. [PMID: 30344079 DOI: 10.1016/j.tcm.2018.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 09/23/2018] [Accepted: 09/24/2018] [Indexed: 11/29/2022]
Abstract
His bundle pacing (HBP) has continued to evolve over the past decade and has started to become a global phenomenon. Evidence is mounting of its clinical benefits as compared to both right ventricular and left ventricular pacing. In this paper, we review recent data in support of His bundle pacing and some of the challenges facing us as we advocate its increasing role in clinical practice.
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Affiliation(s)
- Fatima M Ezzeddine
- Krannert Institute of Cardiology, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Gopi Dandamudi
- Krannert Institute of Cardiology, Indiana University School of Medicine, Indianapolis, IN 46202, USA.
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Abstract
In addition to the His bundle, numerous other sites have been evaluated as more physiologic alternatives to pacing at the right ventricular apex. Several hemodynamic studies have shown the benefit of His bundle pacing and septal pacing in comparison with right ventricular apical pacing. This article summarizes this literature and presents acute hemodynamic data in an intrapatient study examining His bundle pacing, right ventricular septal pacing, and right ventricular apical pacing.
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Affiliation(s)
- Amrish Deshmukh
- Department of Medicine, University of Chicago, 5841 South Maryland Avenue, MC 6092, Chicago, IL 60637, USA
| | - Umashankar Lakshmanadoss
- Cardiac Electrophysiology Division, Ballad Health CVA Heart Institute, 2050 Meadowview Pkwy, Kingsport, TN 37660, USA
| | - Pramod Deshmukh
- Cardiac and Vascular Center, Arrhythmia Center, Robert Packer Hospital, 1 Guthrie Square, Sayre, PA 18840, USA.
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Abstract
His bundle pacing (HBP) has recently emerged as a technique to avoid the negative effects of long-term right ventricular apical pacing. In addition to providing physiologic ventricular activation, HBP has been shown to correct underlying conduction abnormalities in certain patients. Although large prospective, randomized clinical trials have not yet been completed, the available observational clinical data support the safety and efficacy of this technique. Here, we review the physiology of the his bundle (HB) as it relates to HBP, describe the current clinical experience, and discuss future directions of this emerging therapy.
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Vijayaraman P, Chung MK, Dandamudi G, Upadhyay GA, Krishnan K, Crossley G, Bova Campbell K, Lee BK, Refaat MM, Saksena S, Fisher JD, Lakkireddy D. His Bundle Pacing. J Am Coll Cardiol 2018; 72:927-947. [DOI: 10.1016/j.jacc.2018.06.017] [Citation(s) in RCA: 126] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 06/01/2018] [Accepted: 06/04/2018] [Indexed: 01/31/2023]
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Keene D, Arnold A, Shun-Shin MJ, Howard JP, Sohaib SA, Moore P, Tanner M, Quereshi N, Muthumala A, Chandresekeran B, Foley P, Leyva F, Adhya S, Falaschetti E, Tsang H, Vijayaraman P, Cleland JGF, Stegemann B, Francis DP, Whinnett ZI. Rationale and design of the randomized multicentre His Optimized Pacing Evaluated for Heart Failure (HOPE-HF) trial. ESC Heart Fail 2018; 5:965-976. [PMID: 29984912 PMCID: PMC6165934 DOI: 10.1002/ehf2.12315] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 05/08/2018] [Accepted: 05/30/2018] [Indexed: 01/17/2023] Open
Abstract
Aims In patients with heart failure and a pathologically prolonged PR interval, left ventricular (LV) filling can be improved by shortening atrioventricular delay using His‐bundle pacing. His‐bundle pacing delivers physiological ventricular activation and has been shown to improve acute haemodynamic function in this group of patients. In the HOPE‐HF (His Optimized Pacing Evaluated for Heart Failure) trial, we are investigating whether these acute haemodynamic improvements translate into improvements in exercise capacity and heart failure symptoms. Methods and results This multicentre, double‐blind, randomized, crossover study aims to randomize 160 patients with PR prolongation (≥200 ms), LV impairment (EF ≤ 40%), and either narrow QRS (≤140 ms) or right bundle branch block. All patients receive a cardiac device with leads positioned in the right atrium and the His bundle. Eligible patients also receive a defibrillator lead. Those not eligible for implantable cardioverter defibrillator have a backup pacing lead positioned in an LV branch of the coronary sinus. Patients are allocated in random order to 6 months of (i) haemodynamically optimized dual chamber His‐bundle pacing and (ii) backup pacing only, using the non‐His ventricular lead. The primary endpoint is change in exercise capacity assessed by peak oxygen uptake. Secondary endpoints include change in ejection fraction, quality of life scores, B‐type natriuretic peptide, daily patient activity levels, and safety and feasibility assessments of His‐bundle pacing. Conclusions Hope‐HF aims to determine whether correcting PR prolongation in patients with heart failure and narrow QRS or right bundle branch block using haemodynamically optimized dual chamber His‐bundle pacing improves exercise capacity and symptoms. We aim to complete recruitment by the end of 2018 and report in 2020.
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Affiliation(s)
- Daniel Keene
- Imperial College London, London, UK.,Imperial College Healthcare NHS Trust, London, UK
| | - Ahran Arnold
- Imperial College London, London, UK.,Imperial College Healthcare NHS Trust, London, UK
| | - Matthew J Shun-Shin
- Imperial College London, London, UK.,Imperial College Healthcare NHS Trust, London, UK
| | - James P Howard
- Imperial College London, London, UK.,Imperial College Healthcare NHS Trust, London, UK
| | | | - Philip Moore
- West Hertfordshire Hospitals NHS Trust, Hertfordshire, UK.,Barts Health NHS Trust, London, UK
| | - Mark Tanner
- West Sussex Hospitals NHS Trust, West Sussex, UK
| | | | - Amal Muthumala
- Barts Health NHS Trust, London, UK.,North Middlesex University Hospital, London, UK
| | | | - Paul Foley
- Great Western Hospitals NHS Foundation Trust, Swindon, UK
| | | | | | | | - Hilda Tsang
- Imperial College Trials Unit, Imperial College London, London, UK
| | - Pugal Vijayaraman
- Geisinger Commonwealth School of Medicine, Geisinger Heart Institute, Scranton, PA, USA
| | | | - Berthold Stegemann
- Bakken Research Center B.V. Research and Technology, Maastricht, The Netherlands
| | - Darrel P Francis
- Imperial College London, London, UK.,Imperial College Healthcare NHS Trust, London, UK
| | - Zachary I Whinnett
- Imperial College London, London, UK.,Imperial College Healthcare NHS Trust, London, UK
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Vijayaraman P, Naperkowski A, Subzposh FA, Abdelrahman M, Sharma PS, Oren JW, Dandamudi G, Ellenbogen KA. Permanent His-bundle pacing: Long-term lead performance and clinical outcomes. Heart Rhythm 2018; 15:696-702. [DOI: 10.1016/j.hrthm.2017.12.022] [Citation(s) in RCA: 159] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Indexed: 11/25/2022]
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41
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Zanon F, Ellenbogen KA, Dandamudi G, Sharma PS, Huang W, Lustgarten DL, Tung R, Tada H, Koneru JN, Bergemann T, Fagan DH, Hudnall JH, Vijayaraman P. Permanent His-bundle pacing: a systematic literature review and meta-analysis. Europace 2018; 20:1819-1826. [DOI: 10.1093/europace/euy058] [Citation(s) in RCA: 143] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 03/10/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Francesco Zanon
- Arrhythmia and Electrophysiology Unit, Cardiology Department, Santa Maria Della Misericordia Hospital, 140, Viale Tre Martiri, Rovigo, Italy
| | | | - Gopi Dandamudi
- Department of Medicine, Krannert Institute of Cardiology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Parikshit S Sharma
- Division of Cardiology, Rush University Medical Center, Chicago, IL, USA
| | - Weijian Huang
- Department of Cardiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China, The Key Lab of Cardiovascular Disease of Wenzhou, Wenzhou, China
| | - Daniel L Lustgarten
- Department of Internal Medicine, Division of Cardiology, University of Vermont College of Medicine, Burlington, VT, USA
| | - Roderick Tung
- University of Chicago Medicine, Center for Arrhythmia Care, Pritzker School of Medicine, Chicago, IL, USA
| | - Hiroshi Tada
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Jayanthi N Koneru
- Division of Cardiology, Virginia Commonwealth University, Richmond, VA, USA
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Abstract
Traditional right ventricular pacing can be associated with adverse remodeling, leading to left ventricular dysfunction, functional mitral regurgitation, left atrial dilatation, as well as atrial and ventricular arrhythmias. His bundle pacing (HBP) has emerged as a viable and reliable alternative to right ventricular pacing. HBP has been around since the 1970s, but remained dormant even after the index clinical study in humans in 2000. However, with recently rejuvenated interest, it appears to be a promising strategy for achieving synchronous ventricular pacing. Multiple studies have now shown that HBP is feasible, safe, and offers better outcomes when compared with right ventricular pacing. It has also emerged as an alternative to biventricular pacing for the provision of cardiac resynchronization therapy. This review gives a systematic appraisal of the history, feasibility, safety, techniques, efficacy, benefits, complications, and challenges, and offers a future perspective, of HBP.
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Huang WA, Wassie MA, Ajijola OA. Permanent His Bundle Pacing for Cardiac Resynchronization. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2018; 20:23. [PMID: 29508149 DOI: 10.1007/s11936-018-0616-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
His bundle pacing (HBP) has been shown to be a feasible, beneficial, and safe way to achieve cardiac resynchronization therapy (CRT) with recruitment of the heart's physiological conduction system. HBP should be considered for those with unfavorable coronary sinus (CS) anatomy, and nonresponders to biventricular (BiV) pacing. HBP CRT may also help patients with the nonleft bundle branch block form of conduction delay and heart failure (HF). HBP CRT should be considered strongly in preventing right ventricular (RV) pacing-induced cardiomyopathy, especially after atrioventricular nodal ablation given the discrete nature of the block and the low likelihood of distal block. With increased operator experience and improved lead delivery systems, HBP success rates and safety have improved and are comparable to traditional RV pacing. Battery longevity is also likely comparable to traditional BiV CRT devices. We anticipate the use of HBP CRT growing significantly.
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Affiliation(s)
- William A Huang
- UCLA Cardiac Arrhythmia Center, University of California, Los Angeles, CA, USA
| | - Maereg A Wassie
- UCLA Cardiac Arrhythmia Center, University of California, Los Angeles, CA, USA
| | - Olujimi A Ajijola
- UCLA Cardiac Arrhythmia Center, University of California, Los Angeles, CA, USA. .,UCLA Neurocardiology Research Center, David Geffen School of Medicine at UCLA, 100 Medical Plaza, Suite 660, Westwood Blvd, Los Angeles, CA, 90095-1679, USA.
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Vijayaraman P, Dandamudi G, Zanon F, Sharma PS, Tung R, Huang W, Koneru J, Tada H, Ellenbogen KA, Lustgarten DL. Permanent His bundle pacing: Recommendations from a Multicenter His Bundle Pacing Collaborative Working Group for standardization of definitions, implant measurements, and follow-up. Heart Rhythm 2018; 15:460-468. [DOI: 10.1016/j.hrthm.2017.10.039] [Citation(s) in RCA: 175] [Impact Index Per Article: 29.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Indexed: 10/18/2022]
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Yu Z, Chen R, Su Y, Chen X, Qin S, Li M, Han F, Ge J. Integrative and quantitive evaluation of the efficacy of his bundle related pacing in comparison with conventional right ventricular pacing: a meta-analysis. BMC Cardiovasc Disord 2017; 17:221. [PMID: 28800733 PMCID: PMC5553603 DOI: 10.1186/s12872-017-0649-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 07/27/2017] [Indexed: 11/23/2022] Open
Abstract
Background Long-term RVP could bring adverse problems to cardiac electro-mechanics and result in inter- and intra-ventricular asynchrony, impaired labor force, and aggravation of cardiac function. HBRP including direct His bundle pacing and para-His bundle pacing was regarded as a novel physiological pacing pattern to avoid devastating cardiac function. This synthetic study was conducted to integratively and quantitatively evaluate the efficacy of His bundle related pacing (HBRP) in comparison with conventional right ventricular pacing (RVP). Methods Published studies on comparison of left ventricular ejection fraction (LVEF), left ventricular end diastolic volume (LVEDV), left ventricular end systolic volume (LVESV), New York Heart Association (NYHA) class, inter-ventricular asynchrony, and QRS duration, etc. between HBRP and RVP were collected and for meta-analysis. Results HBRP showed higher LVEF (WMD = 3.9%, 95% CI: 1.6% – 6.1%), lower NYHA class (WMD = −0.5, 95% CI: -0.7 – -0.3), WMD of LVESV = −0.1 ml, 95% CI: -3.0 – 2.8 ml), less inter-ventricular asynchrony (WMD = −13.2 ms, 95% CI: -16.4 – -10.0 ms), and shorter QRS duration for long-term (WMD = −36.9 ms, 95% CI: -40.0 – -33.8 ms), however, no significant difference of ventricular volume (WMDLVEDV = −2.4 ml, 95% CI: -5.0 – 0.2 ml; WMDLVESV = −0.1 ml, 95% CI: -3.0 – 2.8 ml) compared to RVP. Conclusions The efficacy of HBRP was firstly verified by meta-analysis to date. Compared with RVP, HBRP markedly preserve LVEF, NYHA class, and QRS duration. However, it seemed to have less effect on ventricular volume. Electronic supplementary material The online version of this article (doi:10.1186/s12872-017-0649-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ziqing Yu
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, 200032, People's Republic of China.,Shanghai Medical College, Fudan University, Shanghai, 200032, People's Republic of China
| | - Ruizhen Chen
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, 200032, People's Republic of China.,Key Laboratory of Viral Heart Diseases, Ministry of Public Health, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Yangang Su
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, 200032, People's Republic of China.
| | - Xueying Chen
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, 200032, People's Republic of China
| | - Shengmei Qin
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, 200032, People's Republic of China
| | - Minghui Li
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, 200032, People's Republic of China.,Key Laboratory of Viral Heart Diseases, Ministry of Public Health, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Fei Han
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, 200032, People's Republic of China.,Shanghai Medical College, Fudan University, Shanghai, 200032, People's Republic of China
| | - Junbo Ge
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, 200032, People's Republic of China.
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Selective versus non-selective his bundle pacing for cardiac resynchronization therapy. J Electrocardiol 2017; 50:191-194. [DOI: 10.1016/j.jelectrocard.2016.10.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Indexed: 11/19/2022]
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Ferrando-Castagnetto F, Ricca-Mallada R, Vidal A, Ferrando R. [Effects of prolonged endocardial stimulation on left ventricular mechanical synchrony. A pilot study applying gated-SPECT phase analysis. Endocardial stimulation and dyssynchrony]. ARCHIVOS DE CARDIOLOGIA DE MEXICO 2017; 87:307-315. [PMID: 28131806 DOI: 10.1016/j.acmx.2016.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 12/16/2016] [Accepted: 12/19/2016] [Indexed: 11/25/2022] Open
Abstract
OBJETIVE To evaluate left ventricular mechanical dyssynchrony (LVMD) associated with prolonged right ventricular pacing through an innovative imaging technique as a pilot study in Uruguay. METHODS A 99mTc-MIBI gated-SPECT and phase analysis was performed in 12 patients with pace-makers implanted at least one year before scintigraphy, due to advanced atrioventricular block. Clinical data, QRS duration, rate, mode and site of pacing in right ventricle, chamber diameters, presence and extension of myocardial scar and ischaemia, as well as LVEF at rest, were recorded. Using V-Sync of Emory Cardiac Toolbox, a standard deviation (PSD) and bandwidth (PBW) from rest phase histogram was obtained and these indexes were compared with controls in the subgroups of patients with LVEF≥50% and <50%. RESULTS Patients with prolonged RV endocardial pacing exhibited marked LVMD. More severe dyssynchrony was found in patients with impaired LVEF than in patients with preserved LVEF (PSD: 46.67o vs. 26.81o, P<.05; PBW: 144.33o vs. 77.41o, P<.05). Higher left ventricle diameters, extensive infarct, or significant ischaemia were found in patients with impaired LVEF. CONCLUSIONS Chronic right ventricular pacing was invariably associated with LVMD, even when systolic function was preserved. Phase analysis could be a potentially useful technique to evaluate LMVD associated with myocardial scar in patients with pacemakers, and to decide promptly the upgrading to biventricular pacing.
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Affiliation(s)
- Federico Ferrando-Castagnetto
- Departamento de Cardiología-Centro Cardiovascular Universitario, Hospital de Clínicas, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay; Servicio de Medicina Nuclear-Centro Asistencial del Sindicato Médico, Montevideo, Uruguay.
| | - Roberto Ricca-Mallada
- Departamento de Cardiología-Centro Cardiovascular Universitario, Hospital de Clínicas, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
| | - Alejandro Vidal
- Departamento de Cardiología-Centro Cardiovascular Universitario, Hospital de Clínicas, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
| | - Rodolfo Ferrando
- Servicio de Medicina Nuclear-Centro Asistencial del Sindicato Médico, Montevideo, Uruguay
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DANDAMUDI GOPI, VIJAYARAMAN PUGAZHENDHI. Trials and Tribulations of Ventricular Pacing. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2016; 39:1313-1316. [DOI: 10.1111/pace.12921] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Revised: 07/09/2016] [Accepted: 07/18/2016] [Indexed: 01/31/2023]
Affiliation(s)
- GOPI DANDAMUDI
- Indiana University School of Medicine; Indianapolis Indiana
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Das A, Kahali D. Physiological cardiac pacing: Current status. Indian Heart J 2016; 68:552-8. [PMID: 27543481 PMCID: PMC4990729 DOI: 10.1016/j.ihj.2016.03.033] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 03/09/2016] [Accepted: 03/28/2016] [Indexed: 11/16/2022] Open
Abstract
Adverse hemodynamics of right ventricular (RV) pacing is a well-known fact. It was believed to be the result of atrio-ventricular (AV) dyssynchrony and sequential pacing of the atrium and ventricle may solve these problems. However, despite maintenance of AV synchrony, the dual chamber pacemakers in different trials have failed to show its superiority over single chamber RV apical pacing in terms of death, progression of heart failure, and atrial fibrillation (AF). As a consequence, investigators searched for alternate pacing sites with a more physiological activation pattern and better hemodynamics. Direct His bundle pacing and Para-Hisian pacing are the most physiological ventricular pacing sites. But, this is technically difficult. Ventricular septal pacing compared to apical pacing results in a shorter electrical activation delay and consequently less mechanical dyssynchrony. But, the study results are heterogeneous. Selective site atria pacing (atrial septal) is useful for patients with atrial conduction disorders in prevention of AF.
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Affiliation(s)
- Asit Das
- RMO-cum-Clinical Tutor, Department of Cardiology, IPGME&R and SSKM Hospital, Kolkata, India.
| | - Dhiman Kahali
- Senior Interventional Cardiologist, B. M. Birla Heart Research Centre, Kolkata, India
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