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Qi P, An H, Lv Y, Geng Y, Chen S, Li S, Dang Y. His-Purkinje conduction system pacing and atrioventricular node ablation in treatment of persistent atrial fibrillation refractory to multiple ablation procedures: A case report. SAGE Open Med Case Rep 2023; 11:2050313X231172873. [PMID: 37187494 PMCID: PMC10176781 DOI: 10.1177/2050313x231172873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 04/13/2023] [Indexed: 05/17/2023] Open
Abstract
In patients with symptomatic atrial fibrillation refractory to optimal medical therapy, atrioventricular node ablation followed by permanent pacemaker implantation is an effective treatment option. A 66-year-old woman with symptomatic persistent atrial fibrillation refractory to multiple ablation procedures was referred to our institution. After optimal drug therapy, the patient still had obvious symptoms. Sequential His-Purkinje conduction system pacing and atrioventricular node ablation were performed. Left bundle branch pacing was used as a backup pacing method if thresholds of His bundle pacing were too high or loss of His bundle capture occurred in the follow-up. At the 6-month follow-up, the European Heart Rhythm Association classification for AF was improved, the score of the Atrial Fibrillation Effect on Quality of Life was enhanced, and the 6-Minute Walk Test was ameliorated. The present case was subjected to His-Purkinje conduction system pacing in combination with atrioventricular node ablation as treatment for a symptomatic persistent atrial fibrillation refractory to multiple ablation procedures, and this procedure alleviated symptoms and improved the quality of life in a short-term follow-up.
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Affiliation(s)
| | | | | | | | | | | | - Yi Dang
- Yi Dang, Heart Center, Hebei General Hospital,
Shijiazhuang 050051, Hebei, China.
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2
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Pujol‐López M, Jiménez Arjona R, Guasch E, Borràs R, Doltra A, Vázquez‐Calvo S, Roca‐Luque I, Garre P, Ferró E, Niebla M, Carro E, Puente JL, Uribe L, Invers E, Castel MÁ, Arbelo E, Sitges M, Mont L, Tolosana JM. Conduction system pacing vs. biventricular pacing in patients with ventricular dysfunction and AV block. Pacing Clin Electrophysiol 2022; 45:1115-1123. [PMID: 35583311 PMCID: PMC9796875 DOI: 10.1111/pace.14535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 03/11/2022] [Accepted: 05/13/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND It is unknown whether His-Purkinje conduction system pacing (HPCSP), as either His bundle or left bundle branch pacing, could be an alternative to cardiac resynchronization therapy (BiVCRT) for patients with left ventricular dysfunction needing ventricular pacing due to atrioventricular block. The aim of the study is to compare the echocardiographic response and clinical improvement between HPCSP and BiVCRT. METHODS Consecutive patients who successfully received HPCSP were compared with a historical cohort of BiVCRT patients. Patients were 1:1 matched by age, LVEF, atrial fibrillation, renal function and cardiomyopathy type. Responders were defined as patients who survived, did not require heart transplantation and increased LVEF ≥5 points at 6-month follow-up. RESULTS HPCSP was successfully achieved in 92.5% (25/27) of patients. During follow-up, 8% (2/25) of HPCSP patients died and 4% (1/25) received a heart transplant, whereas 4% (1/25) of those in the BiVCRT cohort died. LVEF improvement was 10% ± 8% HPCSP versus 7% ± 5% BiVCRT (p = .24), and the percentage of responders was 76% (19/25) HPCSP versus 64% (16/25) BiVCRT (p = .33). Among survivors, the percentage of patients who improved from baseline II-IV mitral regurgitation (MR) to 0-I MR was 9/11 (82%) versus 2/8 (25%) (p = .02). Compared to those with BiVCRT, patients with HPCSP achieved better NYHA improvement: 1 point versus 0.5 (OR 0.34; p = .02). CONCLUSION HPCSP in patients with LVEF ≤45% and atrioventricular block improved the LVEF and induced a response similar to that of BiVCRT. HPCSP significantly improved MR and NYHA functional class. HPCSP may be an alternative to BiVCRT in these patients. (Figure 1. Central Illustration). [Figure: see text].
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Affiliation(s)
- Margarida Pujol‐López
- Institut Clínic Cardiovascular (ICCV), Hospital ClínicUniversitat de BarcelonaCataloniaSpain,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)BarcelonaCataloniaSpain
| | - Rafael Jiménez Arjona
- Institut Clínic Cardiovascular (ICCV), Hospital ClínicUniversitat de BarcelonaCataloniaSpain
| | - Eduard Guasch
- Institut Clínic Cardiovascular (ICCV), Hospital ClínicUniversitat de BarcelonaCataloniaSpain,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)BarcelonaCataloniaSpain,Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV)MadridSpain,Medicine Department of School of MedicineUniversitat de BarcelonaBarcelonaCatalonia08036Spain
| | - Roger Borràs
- Institut Clínic Cardiovascular (ICCV), Hospital ClínicUniversitat de BarcelonaCataloniaSpain,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)BarcelonaCataloniaSpain,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos IIIMadridSpain
| | - Adelina Doltra
- Institut Clínic Cardiovascular (ICCV), Hospital ClínicUniversitat de BarcelonaCataloniaSpain,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)BarcelonaCataloniaSpain
| | - Sara Vázquez‐Calvo
- Institut Clínic Cardiovascular (ICCV), Hospital ClínicUniversitat de BarcelonaCataloniaSpain
| | - Ivo Roca‐Luque
- Institut Clínic Cardiovascular (ICCV), Hospital ClínicUniversitat de BarcelonaCataloniaSpain,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)BarcelonaCataloniaSpain,Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV)MadridSpain,Medicine Department of School of MedicineUniversitat de BarcelonaBarcelonaCatalonia08036Spain
| | - Paz Garre
- Institut Clínic Cardiovascular (ICCV), Hospital ClínicUniversitat de BarcelonaCataloniaSpain,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)BarcelonaCataloniaSpain
| | | | - Mireia Niebla
- Institut Clínic Cardiovascular (ICCV), Hospital ClínicUniversitat de BarcelonaCataloniaSpain
| | - Esther Carro
- Institut Clínic Cardiovascular (ICCV), Hospital ClínicUniversitat de BarcelonaCataloniaSpain
| | - Jose L. Puente
- Institut Clínic Cardiovascular (ICCV), Hospital ClínicUniversitat de BarcelonaCataloniaSpain
| | - Laura Uribe
- Institut Clínic Cardiovascular (ICCV), Hospital ClínicUniversitat de BarcelonaCataloniaSpain
| | - Eric Invers
- Institut Clínic Cardiovascular (ICCV), Hospital ClínicUniversitat de BarcelonaCataloniaSpain,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)BarcelonaCataloniaSpain
| | - Maria Ángeles Castel
- Institut Clínic Cardiovascular (ICCV), Hospital ClínicUniversitat de BarcelonaCataloniaSpain,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)BarcelonaCataloniaSpain,Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV)MadridSpain
| | - Elena Arbelo
- Institut Clínic Cardiovascular (ICCV), Hospital ClínicUniversitat de BarcelonaCataloniaSpain,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)BarcelonaCataloniaSpain,Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV)MadridSpain
| | - Marta Sitges
- Institut Clínic Cardiovascular (ICCV), Hospital ClínicUniversitat de BarcelonaCataloniaSpain,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)BarcelonaCataloniaSpain,Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV)MadridSpain,Medicine Department of School of MedicineUniversitat de BarcelonaBarcelonaCatalonia08036Spain
| | - Lluís Mont
- Institut Clínic Cardiovascular (ICCV), Hospital ClínicUniversitat de BarcelonaCataloniaSpain,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)BarcelonaCataloniaSpain,Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV)MadridSpain,Medicine Department of School of MedicineUniversitat de BarcelonaBarcelonaCatalonia08036Spain
| | - José M. Tolosana
- Institut Clínic Cardiovascular (ICCV), Hospital ClínicUniversitat de BarcelonaCataloniaSpain,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)BarcelonaCataloniaSpain,Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV)MadridSpain,Medicine Department of School of MedicineUniversitat de BarcelonaBarcelonaCatalonia08036Spain
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Zheng R, Yao H, Lian L. His-Purkinje conduction system pacing for pacing-induced cardiomyopathy: a systematic literature review and meta-analysis. J Interv Card Electrophysiol 2022. [PMID: 35804257 DOI: 10.1007/s10840-022-01296-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 06/29/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Upgrading to His-Purkinje conduction system pacing (HPCSP) has been proven to reverse ventricular remodeling and improve cardiac function in patients with pacing-induced cardiomyopathy (PICM). This meta-analysis aimed to assess the efficacy and clinical benefit of upgrading to HPCSP in patients with PICM after chronic right ventricular pacing (RVP). METHODS We systematically searched PubMed, Cochrane Library, and Embase for relevant articles from databases' establishment to April 22, 2022. Clinical outcomes and pacing parameters included left ventricular ejection fraction (LVEF) pre-RVP, pre-HPCSP, and during follow-up, New York Heart Association (NYHA) functional class at baseline and follow-up, lead-related complications, heart failure hospitalization (HFH), all-cause mortality, pacing thresholds at implant and during follow-up, and QRS duration (QRSd) pre-RVP, pre-HPCSP, and during follow-up. RESULTS A total of 6 articles including 144 patients were enrolled in this meta-analysis. QRSd increased from 127 ± 29 ms at baseline to 175 ± 19 ms (P < 0.001) during RVP and then significantly narrowed to 116 ± 18 ms (P < 0.001) after upgrading to HPCSP. During a mean follow-up of 17.9 ± 10.5 months, LVEF improved from 35 ± 8% pre-HPSCP to 48 ± 12% after upgrading to HPCSP (P < 0.001). The capture thresholds were 1.2 ± 0.9 V at baseline and increased slightly during follow-up. NYHA functional class improved significantly from 2.7 ± 0.8 to 1.9 ± 0.8 during follow-up (P < 0.001). CONCLUSION Our meta-analysis indicates that upgrading to HPCSP in patients with PICM is feasible and efficient, as it significantly improves electrical synchrony and cardiac function.
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4
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Guan XM, Li DN, Zhao FL, Zhao YN, Yang YH, Dai BL, Dai SY, Gao LJ, Xia YL, Dong YX. Short QRS Duration After His-Purkinje Conduction System Pacing Predicts Left Ventricular Complete Reverse Remodeling in Patients With True Left Bundle Branch Block and Heart Failure. Front Cardiovasc Med 2022; 9:824194. [PMID: 35600487 PMCID: PMC9120422 DOI: 10.3389/fcvm.2022.824194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 04/08/2022] [Indexed: 11/13/2022] Open
Abstract
Objective This study aimed to explore the outcomes of His-Purkinje conduction system pacing (HPCSP) and to screen the predictors of left ventricular (LV) complete reverse remodeling in patients with true left bundle branch block (LBBB) and heart failure with reduced ejection fraction (HFrEF). Methods Patients who underwent HPCSP for true LBBB and HFrEF from April 2018 to August 2020 were consecutively enrolled. All participants were followed up for at least 1 year. Thrombosis, infection, lead dislodgement, perforation, and other complications were observed after HPCSP. Clinical data, including echocardiographic parameters, electrocardiogram measurements, and cardiac function, were assessed before and after the procedure. Results A total of 46 patients were enrolled. HPCSP was successfully deployed in 42 cases (91.30%), which included 37 cases with His bundle pacing (HBP) and 5 cases with left bundle branch pacing (LBBP). The QRS duration decreased significantly (169.88 ± 19.17 ms vs. 113.67 ± 20.68 ms, P < 0.001). Left ventricular end-systolic volume (LVESV) (167.67 ± 73.20 ml vs. 85.97 ± 62.24 ml, P < 0.001), left ventricular end-diastolic diameter (LVEDD) (63.57 ± 8.19 mm vs. 55.46 ± 9.63 mm, P = 0.003) and left ventricular ejection fraction (LVEF) (26.52 ± 5.60% vs. 41.86 ± 11.56%, P < 0.001) improved dramatically. Complete reverse remodeling of the LV with normalized LVEF and LVEDD was found in nearly half of the patients (45.24%). A short QRS duration after HPCSP was a strong predictor of normalized LVEF and LVEDD (P < 0.001). The thresholds increased markedly in two patients approximately 6 months after HBP. No patients died during the total follow-up period of 20.07 ± 6.45 months. Conclusion Complete reverse remodeling of the LV could be found in nearly half of the patients with HFrEF and true LBBB after HPCSP, and the short QRS duration after HPCSP was a strong predictor.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Yun-Long Xia
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Ying-Xue Dong
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
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5
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Chen X, Zhou X, Wang Y, Jin Q, Chen Y, Wang J, Qin S, Bai J, Wang W, Liang Y, Chen H, Su Y, Ge J. Evaluation of electrophysiological characteristics and ventricular synchrony: An intrapatient-controlled study during His-Purkinje conduction system pacing versus right ventricular pacing. Clin Cardiol 2022; 45:723-732. [PMID: 35502628 PMCID: PMC9286324 DOI: 10.1002/clc.23837] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 03/24/2022] [Accepted: 03/29/2022] [Indexed: 12/17/2022] Open
Abstract
Objectives to Background To compare electromechanical ventricular synchrony when pacing from different sites, including right ventricular apex pacing (RVAP), right ventricular septum pacing (RVSP), His bundle pacing (HBP), left bundle branch pacing (LBBP), and RVSP during unipolar pacing from the ring electrode of LBBP lead (RVSPring) in each patient and evaluate the correlations between electrophysiological characteristics and ventricular synchrony. Methods Twenty patients with complete atrioventricular block indicated for dual‐chamber pacemaker implantation were included in the study. Unipolar pacing at different sites, including RVAP, RVSP, HBP, LBBP, and RVSPring, was successively performed in each patient. The pacing characteristics and echocardiogram parameters were collected and compared among intrinsic rhythm and pacing at different sites. Results Similar to HBP (114.84 ± 18.67 ms), narrower paced QRSd was found in LBBP (116.15 ± 11.60 ms) as compared to RVSPring (135.11 ± 13.68 ms), RVSP (141.65 ± 14.26 ms), and RVAP (160.15 ± 19.35 ms) (p < .001). LBBP showed comparable pacing parameters to RVAP or RVSP and was significantly better than HBP, with maintained cardiac function. TS‐12‐SD was significantly improved in LBBP (41.80 ± 20.97 ms) than RVAP (69.70 ± 32.42 ms, p = .003) and RVSP (63.30.56 ± 32.53 ms, p = .018) but similar to HBP (51.50 ± 25.67 ms, p = .283) or RVSPring (57.80 ± 25.65 ms, p = .198). Among these pacing strategies, negative values of interventricular mechanical delay (IVMD) were only identified in LBBP (−19.25 ± 18.43 ms), significantly different from RVAP (35.00 ± 30.72 ms), RVSP (22.85 ± 22.05 ms), HBP (5.20 ± 18.64 ms), and RVSPring (16.00 ± 26.76 ms (all p < .05). Using Pearson's analysis, Sti‐LVAT was positively correlated with QRS duration, IVMD, TS‐12‐SD, LVEDV, and LVESV, while a negative relationship could be observed for left ventricular ejection fraction. Conclusions His‐Purkinje conduction system pacing (HPCSP) achieved better electrical and mechanical synchrony than conventional RV pacing. For interventricular synchrony, only LBBP initiated earlier LV activation than RV, in accordance with the right bundle branch block (RBBB) pattern of paced QRS during LBBP. Sti‐LVAT might be a good parameter correlating with LV systolic function and mechanical synchrony.
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Affiliation(s)
- Xueying Chen
- Department of Cardiology, National Clinical Research Center for Interventional Medicine, Shanghai Clinical Research Center for Interventional Medicine, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital of Fudan University, Shanghai, China
| | - Xiaolan Zhou
- Huashan Worldwide Medical Center, Huashan Hospital, Fudan University, Shanghai, China
| | - Yanan Wang
- Department of Echocardiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Qinchun Jin
- Department of Cardiology, National Clinical Research Center for Interventional Medicine, Shanghai Clinical Research Center for Interventional Medicine, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital of Fudan University, Shanghai, China
| | - Yufei Chen
- Department of Echocardiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jingfeng Wang
- Department of Cardiology, National Clinical Research Center for Interventional Medicine, Shanghai Clinical Research Center for Interventional Medicine, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital of Fudan University, Shanghai, China
| | - Shengmei Qin
- Department of Cardiology, National Clinical Research Center for Interventional Medicine, Shanghai Clinical Research Center for Interventional Medicine, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital of Fudan University, Shanghai, China
| | - Jin Bai
- Department of Cardiology, National Clinical Research Center for Interventional Medicine, Shanghai Clinical Research Center for Interventional Medicine, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital of Fudan University, Shanghai, China
| | - Wei Wang
- Department of Cardiology, National Clinical Research Center for Interventional Medicine, Shanghai Clinical Research Center for Interventional Medicine, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital of Fudan University, Shanghai, China
| | - Yixiu Liang
- Department of Cardiology, National Clinical Research Center for Interventional Medicine, Shanghai Clinical Research Center for Interventional Medicine, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital of Fudan University, Shanghai, China
| | - Haiyan Chen
- Department of Echocardiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yangang Su
- Department of Cardiology, National Clinical Research Center for Interventional Medicine, Shanghai Clinical Research Center for Interventional Medicine, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital of Fudan University, Shanghai, China
| | - Junbo Ge
- Department of Cardiology, National Clinical Research Center for Interventional Medicine, Shanghai Clinical Research Center for Interventional Medicine, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital of Fudan University, Shanghai, China
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Pujol-López M, Jiménez Arjona R, Guasch E, Doltra A, Borràs R, Roca Luque I, Castel MÁ, Garre P, Ferró E, Niebla M, Carro E, Arbelo E, Sitges M, Tolosana JM, Mont L. Septal Flash Correction with His-Purkinje Pacing Predicts Echocardiographic Response in Resynchronization Therapy. Pacing Clin Electrophysiol 2022; 45:374-383. [PMID: 35015308 PMCID: PMC9303224 DOI: 10.1111/pace.14445] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 12/27/2021] [Accepted: 01/02/2022] [Indexed: 11/26/2022]
Abstract
Background His‐Purkinje conduction system pacing (HPCSP) has been proposed as an alternative to Cardiac Resynchronization Therapy (CRT); however, predictors of echocardiographic response have not been described in this population. Septal flash (SF), a fast contraction and relaxation of the septum, is a marker of intraventricular dyssynchrony. Methods The study aimed to analyze whether HPCSP corrects SF in patients with CRT indication, and if correction of SF predicts echocardiographic response. This retrospective analysis of prospectively collected data included 30 patients. Left ventricular ejection fraction (LVEF) was measured with echocardiography at baseline and at 6‐month follow‐up. Echocardiographic response was defined as increase in five points in LVEF. Results HPCSP shortened QRS duration by 48 ± 21 ms and SF was significantly decreased (baseline 3.6 ± 2.2 mm vs. HPCSP 1.5 ± 1.5 mm p < .0001). At 6‐month follow‐up, mean LVEF improvement was 8.6% ± 8.7% and 64% of patients were responders. There was a significant correlation between SF correction and increased LVEF (r = .61, p = .004). A correction of ≥1.5 mm (baseline SF – paced SF) had a sensitivity of 81% and 80% specificity to predict echocardiographic response (area under the curve 0.856, p = .019). Conclusion HPCSP improves intraventricular dyssynchrony and results in 64% echocardiographic responders at 6‐month follow‐up. Dyssynchrony improvement with SF correction may predict echocardiographic response at 6‐month follow‐up.
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Affiliation(s)
- Margarida Pujol-López
- Institut Clínic Cardiovascular (ICCV), Hospital Clínic, Universitat de Barcelona, Catalonia, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
| | - Rafael Jiménez Arjona
- Institut Clínic Cardiovascular (ICCV), Hospital Clínic, Universitat de Barcelona, Catalonia, Spain
| | - Eduard Guasch
- Institut Clínic Cardiovascular (ICCV), Hospital Clínic, Universitat de Barcelona, Catalonia, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain.,Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Adelina Doltra
- Institut Clínic Cardiovascular (ICCV), Hospital Clínic, Universitat de Barcelona, Catalonia, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
| | - Roger Borràs
- Institut Clínic Cardiovascular (ICCV), Hospital Clínic, Universitat de Barcelona, Catalonia, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
| | - Ivo Roca Luque
- Institut Clínic Cardiovascular (ICCV), Hospital Clínic, Universitat de Barcelona, Catalonia, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
| | - M Ángeles Castel
- Institut Clínic Cardiovascular (ICCV), Hospital Clínic, Universitat de Barcelona, Catalonia, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain.,Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Paz Garre
- Institut Clínic Cardiovascular (ICCV), Hospital Clínic, Universitat de Barcelona, Catalonia, Spain
| | - Elisenda Ferró
- Medtronic Iberica, Madrid, Spain.,Fundació Clínic per a la Recerca Biomèdica (FCRB), Barcelona, Catalonia, Spain
| | - Mireia Niebla
- Institut Clínic Cardiovascular (ICCV), Hospital Clínic, Universitat de Barcelona, Catalonia, Spain
| | - Esther Carro
- Institut Clínic Cardiovascular (ICCV), Hospital Clínic, Universitat de Barcelona, Catalonia, Spain
| | - Elena Arbelo
- Institut Clínic Cardiovascular (ICCV), Hospital Clínic, Universitat de Barcelona, Catalonia, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain.,Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Marta Sitges
- Institut Clínic Cardiovascular (ICCV), Hospital Clínic, Universitat de Barcelona, Catalonia, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain.,Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - José M Tolosana
- Institut Clínic Cardiovascular (ICCV), Hospital Clínic, Universitat de Barcelona, Catalonia, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain.,Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Lluís Mont
- Institut Clínic Cardiovascular (ICCV), Hospital Clínic, Universitat de Barcelona, Catalonia, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain.,Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
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7
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Qu Q, Sun JY, Zhang ZY, Kan JY, Wu LD, Li F, Wang RX. His-Purkinje conduction system pacing: A systematic review and network meta-analysis in bradycardia and conduction disorders. J Cardiovasc Electrophysiol 2021; 32:3245-3258. [PMID: 34664764 DOI: 10.1111/jce.15269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 09/28/2021] [Accepted: 10/05/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND His-Purkinje conduction system pacing (HPCSP) has emerged as an effective alternative to overcome the limitations of right ventricular pacing (RVP) via physiological left ventricular activation, but there remains a paucity of comparative information for His bundle pacing (HBP) and left bundle branch pacing (LBBP). METHODS A Bayesian random-effects network analysis was conducted to compare the relative effects of HBP, LBBP, and RVP in patients with bradycardia and conduction disorders. PubMed, Embase, Cochrane Library, and Web of Science were systematically searched from database inception until September 21, 2021. RESULTS Twenty-eight studies involving 4160 patients were included in this meta-analysis. LBBP significantly improved success rate, pacing threshold, pacing impedance, and R-wave amplitude compared with HBP. LBBP also demonstrated a nonsignificant trend towards superior outcomes of lead complications, heart failure hospitalization, atrial fibrillation, and all-cause death. However, HBP was associated with significantly shorter paced QRS duration relative to LBBP. Despite higher success rates, shorter procedure/fluoroscopy duration, and fewer lead complications, patients receiving RVP were more likely to experience reduced left ventricular ejection fraction, longer paced QRS duration, and higher rates of heart failure hospitalization than those receiving HPCSP. No statistical differences were observed in the remaining outcome measures. CONCLUSIONS This network meta-analysis demonstrates the efficacy and safety of HPCSP for the treatment of bradycardia and conduction disorders, with differences in pacing parameters, electrophysiology characteristics, and clinical outcomes between HBP and LBBP. Larger-scale, long-term comparative studies are warranted for further verification.
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Affiliation(s)
- Qiang Qu
- Department of Cardiology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, China.,Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jin-Yu Sun
- Department of Cardiology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, China.,Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Zhen-Ye Zhang
- Department of Cardiology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, China
| | - Jun-Yan Kan
- Department of Cardiology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, China
| | - Li-Da Wu
- Department of Cardiology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, China
| | - Feng Li
- Department of Cardiology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, China
| | - Ru-Xing Wang
- Department of Cardiology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, China
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Vijayaraman P, Patel N, Colburn S, Beer D, Naperkowski A, Subzposh FA. His-Purkinje Conduction System Pacing in Atrioventricular Block: New Insights into Site of Conduction Block. JACC Clin Electrophysiol 2021; 8:73-85. [PMID: 34393084 DOI: 10.1016/j.jacep.2021.07.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 07/06/2021] [Accepted: 07/12/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES This study aims to assess the safety and feasibility of achieving His-Purkinje conduction system pacing (HPCSP) in consecutive patients with atrioventricular block (AVB) and to describe the site of conduction block in patients with infranodal AVB. BACKGROUND HPCSP has evolved as the preferred form of physiologic pacing. Left bundle branch area pacing (LBBAP) has emerged as an effective alternative to His bundle pacing (HBP). METHODS Consecutive patients with AVB referred for pacemaker implantation were included in the study. HBP or LBBAP was attempted in all patients. Site of conduction block was identified as nodal or infranodal (intra-Hisian or infra-Hisian) AVB. RESULTS HPCSP was attempted in 333 consecutive patients with AVB and was successful in 322 (97%) patients. HBP was achieved in 140 patients, LBBAP in 179 patients, and both in 3 patients. Site of conduction block was nodal in 55% and infranodal in 45% (intra-Hisian 89%; infra-Hisian 4%; indeterminate 7%). QRS duration at baseline was 111±27 versus 129±31 (P < 0.001) compared to 126 ± 24 vs 125 ± 21 milliseconds (P = 0.75) during HBP and LBBAP, respectively. HBP thresholds at implant were higher compared to LBBAP (1.2 ± 0.7 V at 0.9 milliseconds vs 0.6 ± 0.3 V at 0.5 milliseconds; P < 0.001) but remained stable during follow-up. Lead revision was required in 3% and 2% of patients with HBP and LBBAP, respectively. CONCLUSIONS HPCSP pacing was successfully performed in 97% of unselected patients with AVB irrespective of the site of conduction block. True infra-Hisian block (distal His-Purkinje conduction disease) is rare. HBP and LBBAP were complementary in achieving stable and low capture thresholds.
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Affiliation(s)
- Pugazhendhi Vijayaraman
- Geisinger Heart Institute, Geisinger Commonwealth School of Medicine, Wilkes-Barre, Pennsylvania, USA.
| | - Neil Patel
- The Wright Center, Scranton, Pennsylvania, USA
| | - Shaun Colburn
- Geisinger Heart Institute, Geisinger Commonwealth School of Medicine, Wilkes-Barre, Pennsylvania, USA
| | - Dominik Beer
- Johns Hopkins University, Baltimore, Maryland, USA
| | - Angela Naperkowski
- Geisinger Heart Institute, Geisinger Commonwealth School of Medicine, Wilkes-Barre, Pennsylvania, USA
| | - Faiz A Subzposh
- Geisinger Heart Institute, Geisinger Commonwealth School of Medicine, Wilkes-Barre, Pennsylvania, USA
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Chen X, Wei L, Bai J, Wang W, Qin S, Wang J, Liang Y, Su Y, Ge J. Procedure-Related Complications of Left Bundle Branch Pacing: A Single-Center Experience. Front Cardiovasc Med 2021; 8:645947. [PMID: 33869306 PMCID: PMC8044788 DOI: 10.3389/fcvm.2021.645947] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 03/01/2021] [Indexed: 12/13/2022] Open
Abstract
Background: Although left bundle branch pacing (LBBP) has emerged as a novel physiological pacing strategy with a low and stable threshold, its safety has not been well-documented. In the present study, we included all the patients with procedure-related complications at our centre to estimate these LBBP cases with unique complications. Methods: We enrolled 612 consecutive patients who received the procedure in Zhongshan Hospital, Fudan University, between January 2018 and July 2020. Regular follow-ups were conducted (at 1, 3, and 6 months in the first year and every 6-12 months from the second year), and the clinical data of the patients with complications were collected and analyzed. Results: With a mean follow-up period of 12.32 ± 5.21 months, procedure-related complications were observed in 10 patients (1.63%) that included two postoperative septum perforations (2/612, 0.33%), two postoperative lead dislodgements (2/612, 0.33%), four intraoperative septum injuries (4/612, 0.65%), and two intraoperative lead fractures (2/612, 0.33%). Pacing parameters were stable during follow-up, and no major complications were observed after lead repositioning in the cases of septum perforation and lead dislodgement. Conclusion: The incidence of procedure-related complications for LBBP, namely postoperative septum perforation, postoperative lead dislodgement, intraoperative septum injury, and intraoperative lead fracture, were low. No adverse clinical outcomes were demonstrated after successful repositioning of the lead and appropriate treatment.
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Affiliation(s)
- Xueying Chen
- Department of Cardiology, Zhongshan Hospital of Fudan University, Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Lanfang Wei
- Department of Cardiology, Xiamen Branch, Zhongshan Hospital, Fudan University, Xiamen, China
| | - Jin Bai
- Department of Cardiology, Zhongshan Hospital of Fudan University, Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Wei Wang
- Department of Cardiology, Zhongshan Hospital of Fudan University, Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Shengmei Qin
- Department of Cardiology, Zhongshan Hospital of Fudan University, Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Jingfeng Wang
- Department of Cardiology, Zhongshan Hospital of Fudan University, Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Yixiu Liang
- Department of Cardiology, Zhongshan Hospital of Fudan University, Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Yangang Su
- Department of Cardiology, Zhongshan Hospital of Fudan University, Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Junbo Ge
- Department of Cardiology, Zhongshan Hospital of Fudan University, Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, Shanghai, China
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Wu S, Cai M, Zheng R, Wang S, Jiang L, Xu L, Shi R, Xiao F, Ellenbogen KA, Cha Y, Su L, Huang W. Impact of QRS morphology on response to conduction system pacing after atrioventricular junction ablation. ESC Heart Fail 2021; 8:1195-1203. [PMID: 33395736 PMCID: PMC8006676 DOI: 10.1002/ehf2.13181] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 11/16/2020] [Accepted: 12/08/2020] [Indexed: 01/03/2023] Open
Abstract
Aims His–Purkinje conduction system pacing (HPCSP) utilizing His (HBP) or left bundle branch pacing (LBBP) in patients with atrial fibrillation (AF) and wide QRS duration has not been well studied. We assessed the benefit of left bundle branch block (LBBB) correction during HPCSP in AF patients undergoing atrioventricular junction (AVJ) ablation with LBBB, compared with those with narrow QRS duration. Methods and results This is an observational study in consecutive patients with typical LBBB or narrow QRS duration in whom we attempted HPCSP after AVJ ablation for refractory AF with a left ventricular ejection fraction (LVEF) ≤ 50%. Echocardiographic responses and clinical outcomes were assessed at baseline and during 1 year of follow‐up. A total of 178 patients were enrolled, of which 170 achieved AVJ ablation + permanent HPCSP (age 69.3 ± 10.1 years; LVEF 34.3 ± 7.7%), 133 (78.2%) patients had a narrow QRS duration, and 37 (21.2%) had an LBBB. The QRS duration changed from a baseline of 159.7 ± 16.6 ms to a paced QRS duration of 110.4 ± 12.7 ms in the LBBB cohort and from 95.6 ± 10.4 to 100.8 ± 14.5 ms (both P < 0.001) in the narrow QRS cohort after AVJ ablation and pacing. Compared with the narrow QRS cohort, the LBBB cohort showed a greater absolute increase in LVEF (+22.3% vs. +14.2%, P < 0.001), higher super responder rate (71.4% vs. 49.2%, P = 0.011), and greater New York Heart Association (NYHA) class improvement (−1.9 vs. −1.4, P < 0.001) at 1 year. Conclusion Patients with LBBB have greater improvement in LVEF and NYHA class function than patients with narrow QRS from HPCSP after AVJ ablation.
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Affiliation(s)
- Shengjie Wu
- Department of Cardiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China.,The Key Lab of Cardiovascular Disease of Wenzhou, Wenzhou, 325000, China
| | - Mengxing Cai
- Department of Cardiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China.,The Key Lab of Cardiovascular Disease of Wenzhou, Wenzhou, 325000, China
| | - Rujie Zheng
- Department of Cardiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China.,The Key Lab of Cardiovascular Disease of Wenzhou, Wenzhou, 325000, China
| | - Songjie Wang
- Department of Cardiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China.,The Key Lab of Cardiovascular Disease of Wenzhou, Wenzhou, 325000, China
| | - Limeng Jiang
- Department of Cardiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China.,The Key Lab of Cardiovascular Disease of Wenzhou, Wenzhou, 325000, China
| | - Lei Xu
- Department of Cardiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China.,The Key Lab of Cardiovascular Disease of Wenzhou, Wenzhou, 325000, China
| | - Ruiyu Shi
- Department of Cardiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China.,The Key Lab of Cardiovascular Disease of Wenzhou, Wenzhou, 325000, China
| | - Fangyi Xiao
- Department of Cardiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China.,The Key Lab of Cardiovascular Disease of Wenzhou, Wenzhou, 325000, China
| | - Kenneth A Ellenbogen
- Department of Cardiology, Virginia Commonwealth University Health System, Richmond, VA, USA
| | - Yongmei Cha
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Lan Su
- Department of Cardiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China.,The Key Lab of Cardiovascular Disease of Wenzhou, Wenzhou, 325000, China
| | - Weijian Huang
- Department of Cardiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China.,The Key Lab of Cardiovascular Disease of Wenzhou, Wenzhou, 325000, China
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