scholarly journals Optimal programming of cardiac resynchronisation therapy with His bundle pacing based on aortic velocity time integral in patients with congestive heart failure and permanent atrial fibrillation

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
K Boczar ◽  
A Zabek ◽  
A Slawuta ◽  
M Debski ◽  
J Gajek ◽  
...  
Keyword(s):  
Cardiac Output ◽  
Biventricular Pacing ◽  
Nyha Class ◽  
Cardiac Resynchronisation Therapy ◽  
Left Ventricular ◽  
Ventricular Pacing ◽  
His Bundle ◽  
His Bundle Pacing ◽  
Time Integral ◽  
Resynchronisation Therapy

Abstract Background Cardiac resynchronisation therapy (CRT) in patients with permanent atrial fibrillation (AF) is usually less effective than in sinus rhythm patients. Recent evidence has shown that His bundle pacing (HBP) might be a valuable alternative to conventional pacing systems resulting in more physiologic electrical activation of the heart. Currently, there is a need to identify the optimal way of CRT + HBP programming in patients with congestive heart failure (CHF) and permanent AF to achieve high cardiac output and improve physical capacity and survival. Purpose The aim of this study was to evaluate the impact of CRT + HBP programming on cardiac output in the early post-operative measurements. Methods We included consecutive patients with: 1. permanent AF, 2. CHF in NYHA class III-IV, 3. bundle branch block with QRS >130 ms or QRS <130 ms and high expected requirement of ventricular pacing, 4. severely reduced left ventricular ejection fraction (LVEF) ≤35%, 5. CHF refractory to optimal medical therapy, 6. implanted CRT + HBP. All patients gave informed consent for CRT + HBP implantation and optimization of device programming. During the early post-operative phase, we aimed to optimize CRT + HBP settings in order to achieve the highest cardiac output assessed by repeated echocardiographic measurements of aortic velocity time integral at various pacing programs (Table 1). Then, we selected the optimal pacing settings of CRT + HBP for each individual patient. Results Study included 17 consecutive patients aged 71.5±6.3 years, 12 were male. Mean LVEF was 24% and median NYHA class was III. The most efficacious method of pacing in terms of aortic VTI was HBP combined with left ventricular pacing (LV) which resulted in median VTI of 22.5. HBP + LV was superior to right ventricular pacing (RV): VTI of 22.5 vs 18.5, P=0.003 and outperformed biventricular pacing: VTI 22.5 vs 18.7, P=0.019. Detailed results are shown in Figure 1. Conclusion His bundle pacing coupled with LV pacing proved to be the most advantageous pacing program setting with regard to cardiac output and it performed significantly better than RV pacing only or biventricular pacing. Our observation supports the use of His bundle pacing in CRT systems in patients with CHF and permanent AF. Figure 1 Funding Acknowledgement Type of funding source: None

scholarly journals His Bundle Pacing: State of the Art

2018 ◽  
Vol 12 (1) ◽  
pp. 57-65 ◽  
Author(s):  
Matthew F Yuyun ◽  
Ghulam Muqtada Chaudhry
Keyword(s):  
Right Ventricular ◽  
Biventricular Pacing ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Future Perspective ◽  
Functional Mitral Regurgitation ◽  
Ventricular Pacing ◽  
Right Ventricular Pacing ◽  
His Bundle ◽  
His Bundle Pacing

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.

Optimisation of Cardiac Resynchronisation Therapy with MultiPoint™ Pacing

2015 ◽  
Vol 4 (3) ◽  
pp. 3
Author(s):  
Antonio Curnis ◽  
David O’Donnell ◽  
Axel Kloppe ◽  
Žarko Calovic ◽  
◽  
...  
Keyword(s):  
Systolic Function ◽  
Biventricular Pacing ◽  
Heart Rhythm ◽  
Cardiac Resynchronisation Therapy ◽  
Left Ventricular ◽  
Optimal Placement ◽  
Jude Medical ◽  
Number Of Patients ◽  
Cardiac Resynchronisation ◽  
Resynchronisation Therapy

Cardiac resynchronisation therapy (CRT) using biventricular pacing is an established therapy for impairment of left ventricular (LV) systolic function in patients with heart failure (HF). Although technological advances have improved outcomes in patients undergoing biventricular pacing, the optimal placement of pacing leads remains challenging, and approximately one third of patients have no response to CRT. This may be due to patient selection and lead placement. Electrical mapping can greatly improve outcomes in CRT and increase the number of patients who derive benefit from the procedure. MultiPoint™ pacing (St Jude Medical, St Paul, MN, US) using a quadripolar lead increases the possibility of finding the best pacing site. In clinical studies, use of MultiPoint pacing in HF patients undergoing CRT has been associated with haemodynamic and clinical benefits compared with conventional biventricular pacing, and these benefits have been sustained at 12 months. This article describes the proceedings of a satellite symposium held at the European Heart Rhythm Association (EHRA) Europace conference held in Milan, Italy, in June 2015.

scholarly journals Alternative sites of ventricular pacing: His bundle pacing

2020 ◽  
Vol 90 (2) ◽  
Author(s):  
Francesco Vetta ◽  
Leonardo Marinaccio ◽  
Giampaolo Vetta
Keyword(s):  
Heart Failure ◽  
Biventricular Pacing ◽  
Scientific Evidence ◽  
Cardiac Pacing ◽  
Cardiac Conduction ◽  
Cardiac Resynchronization ◽  
Conduction Delay ◽  
Ventricular Pacing ◽  
His Bundle ◽  
His Bundle Pacing

Since its introduction right ventricular apical (RVA) pacing has been the mainstay in cardiac pacing. However, in recent years there has been an upsurge of interest in permanent His bundle pacing (HBP), given the scientific evidence of the harmful role of dyssynchronous ventricular activation, induced by RVA pacing, in promoting the onset of heart failure and atrial fibrillation. After an intermediate period in which attention was focused on algorithms aimed at minimizing ventricular pacing, with partially inadequate and harmful results, scientific attention shifted to HBP, which proved to ensure a physiological electro-mechanical activation of the ventricles. The encouraging results obtained have allowed the introduction of HBP in recent guidelines for cardiac pacing in patients with bradicardia and cardiac conduction delay. Recent studies have also demonstrated the potential of HBP in patients with left bundle branch block and heart failure. HBP is promising as an attractive way to achieve physiological stimulation in patients with an indication for cardiac resynchronization therapy (CRT). Comparative studies of HB-CRT and biventricular pacing have shown similar results in numerically modest cohorts, although HB-CRT has been shown to promote better ventricular electrical resynchronization as demonstrated by a greater QRS narrowing. A widespread use of this pacing tecnique also depends on improvements in technology, as well as further validation of effectiveness in large randomised clinical trials

Left bundle branch area pacing as alternative to his bundle pacing for cardiac resynchronisation therapy: a case report

2020 ◽  
pp. 1-3
Author(s):  
Jean-Yves Wielandts ◽  
Alexandre Almorad ◽  
Gabriela Hilfiker ◽  
Anaïs Gauthey ◽  
Sébastien Knecht ◽  
...  
Keyword(s):  
Case Report ◽  
Cardiac Resynchronisation Therapy ◽  
His Bundle ◽  
His Bundle Pacing ◽  
Cardiac Resynchronisation ◽  
Resynchronisation Therapy

scholarly journals Long-term outcomes of His bundle pacing in patients with heart failure with left bundle branch block

Heart ◽  
2018 ◽  
Vol 105 (2) ◽  
pp. 137-143 ◽  
Author(s):  
Weijian Huang ◽  
Lan Su ◽  
Shengjie Wu ◽  
Lei Xu ◽  
Fangyi Xiao ◽  
...  
Keyword(s):  
Heart Failure ◽  
Left Bundle Branch Block ◽  
Nyha Class ◽  
Left Ventricular ◽  
Bundle Branch Block ◽  
His Bundle ◽  
His Bundle Pacing ◽  
Patients With Heart Failure

ObjectivesHis bundle pacing (HBP) can potentially correct left bundle branch block (LBBB). We aimed to assess the efficacy of HBP to correct LBBB and long-term clinical outcomes with HBP in patients with heart failure (HF).MethodsThis is an observational study of patients with HF with typical LBBB who were indicated for pacing therapy and were consecutively enrolled from one centre. Permanent HBP leads were implanted if the LBBB correction threshold was <3.5V/0.5 ms or 3.0 V/1.0 ms. Pacing parameters, left ventricular ejection fraction (LVEF), left ventricular end-systolic volume (LVESV) and New York Heart Association (NYHA) Class were assessed during follow-up.ResultsIn 74 enrolled patients (69.6±9.2 years and 43 men), LBBB correction was acutely achieved in 72 (97.3%) patients, and 56 (75.7%) patients received permanent HBP (pHBP) while 18 patients did not receive permanent HBP (non-permanent HBP), due to no LBBB correction (n=2), high LBBB correction thresholds (n=10) and fixation failure (n=6). The median follow-up period of pHBP was 37.1 (range 15.0–48.7) months. Thirty patients with pHBP had completed 3-year follow-up, with LVEF increased from baseline 32.4±8.9% to 55.9±10.7% (p<0.001), LVESV decreased from a baseline of 137.9±64.1 mL to 52.4±32.6 mL (p<0.001) and NYHA Class improvement from baseline 2.73±0.58 to 1.03±0.18 (p<0.001). LBBB correction threshold remained stable with acute threshold of 2.13±1.19 V/0.5 ms to 2.29±0.92 V/0.5 ms at 3-year follow-up (p>0.05).ConclusionspHBP improved LVEF, LVESV and NYHA Class in patients with HF with typical LBBB.

Abstract 3096: Does The Extent Of Non Viable Myocardium, As Identified By Delayed Enhancement Cardiac Magnetic Resonance, Preclude Response After Cardiac Resynchronization Therapy?

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
C Parsai ◽  
N Bunce ◽  
G.R Sutherland ◽  
A Baltabaeva ◽  
B Bijnens ◽  
...  
Keyword(s):  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Biventricular Pacing ◽  
Nyha Class ◽  
Cardiac Resynchronisation Therapy ◽  
Left Ventricular ◽  
Delayed Enhancement ◽  
Cardiac Resynchronization ◽  
Systolic Volume ◽  
Myocardial Scarring

Cardiac resynchronisation therapy (CRT) is a recognised treatment for symptomatic left ventricular (LV) failure associated with a broad QRS.It has been suggested that >15% myocardial scarring predicted failure to respond to CRT. To determine if the scar burden is a major determinant in response to CRT, we prospectively studied 50 pts (66± 1 years, ischaemic aetiology 57%) undergoing CRT for standard indications at baseline (NYHA: 3±0.4, EF: 23±0.8%, QRS: 150±7 ms, BNP: 495±461 pmol/l) and 6 months post-CRT. Clinical response was defined by a reduction in NYHA class >1 and in BNP level >30%. Reverse LV remodelling was defined as a reduction in end-systolic volume ≥10%. All patients had an echocardiographic examination, including an assessment of dyssynchrony. Additionally, a Cardiac Magnetic Resonance (CMR) study, with delayed enhancement, was performed in patients without contraindications. Of the 30 patients that had CMR, 23 pts (77%) responded clinically to CRT (reduction in NYHA: 1.6±0.6, reduction in BNP: 34±0.4%) and 19/30 (63%) additionally displayed reverse LV remodelling. Among the clinical responders 8 pts (35% of responders) were found to have extensive full thickness myocardial scarring on CMR (in 7 ±1 segments), predominantly in the anteroseptum and apex (86%). Three of these patients also showed significant echocardiographic reverse remodelling. The mechanism of response to CRT in these patients with extensive infarction was more frequently interventricular resynchronisation (43%) or atrio-ventricular resynchronisation (43%) rather than intra-ventricular resynchronisation (14%).The previously suggested 12 segment dyssynchrony index (DI) would have identified none of these responders with extensive myocardial infarction. The DI identified only 7/23 responders (30%). Conclusion : Even patients with extensive myocardial scar are potential responders to CRT and should not be excluded if they fulfil the standard AHA/ESC criteria for biventricular pacing. Intraventricular resynchronisation is not the only mechanism by which patients respond to CRT and measures of intraventricular dyssynchrony alone are inadequate for identifying potential response

scholarly journals Left bundle branch pacing: the new kid on the block

2021 ◽  
Vol 30 (4) ◽  
pp. 571-575
Author(s):  
Andra Gurgu ◽  
Dragos Cozma ◽  
Mihail G. Chelu
Keyword(s):  
Heart Failure ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Current Status ◽  
Ventricular Pacing ◽  
Right Ventricular Pacing ◽  
His Bundle ◽  
His Bundle Pacing ◽  
Physiologic Form ◽  
Increased Risk

Right ventricular pacing is has deletorius effects due to left ventricular dysynchrony and remodelling and may result in heart failure. Over the last decade, His bundle pacing has emerged as the most physiologic form pacing. However, it has limitations, such as higher capture thresholds, lower R wave amplitudes, atrial oversensing, and increased risk for lead revisions from late threshold increase with subsequent premature battery depletion, which has prevented a wider adoption of this technique in routine clinical practice. Left bundle branch pacing has been developed as an alternative physiologic pacing strategy that overcomes most of His bundle pacing limitations. This article summarizes the current status of left bundle branch pacing. Keywords: His bundle pacing, left bundle branch pacing, cardiac resynchronization, therapy heart failure.

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