His-bundle pacing in CHF-patients with narrow QRS and chronic AF – an upgrade from single-chamber to dual-chamber ICD

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Ciesielski ◽  
A Slawuta ◽  
A Zabek ◽  
K Boczar ◽  
B Malecka ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Clinical Status ◽  
Chronic Atrial Fibrillation ◽  
Dual Chamber ◽  
Icd Implantation ◽  
Single Chamber ◽  
His Bundle ◽  
His Bundle Pacing ◽  
Short Period

Abstract   A single-chamber ICD is a standard method for primary SCD prophylaxis. In patients with chronic atrial fibrillation it does not contribute to the regularization of heart rate, which is crucial for proper treatment. Moreover, to avoid the deleterious effect of right ventricular pacing only minority of the patients with single chamber ICD get the appropriate, recommended dose of beta-blockers. The aim of our study was to assess the efficacy of direct His-bundle pacing in a population of patients with congestive heart failure and chronic atrial fibrillation using upgrade from single chamber to dual-chamber ICD and atrial channel to perform the His-bundle pacing Methods The study population included 39 patients (37 men, 2 women) aged 67.2±9.3 years, with CHF and chronic AF implanted primarily with single chamber ICD with established pharmacotherapy and stable clinical status. Results The echocardiography measurements at baseline and during follow-up were presented in the table: During short period (3–6 months) of follow-up the mean values of EF and LV dimensions significantly improved. This was also accompanied by functional status improvement. Conclusions His-bundle-based pacing in CHF-chronic AF patients contributes to significant echocardiographic and clinical improvement. Standard single-chamber ICD implantation in CHF-chronic AF patients yields only SCD prevention without influence on remodeling process. The physiological pacing contributes to better pharmacotherapy. Funding Acknowledgement Type of funding source: None

P5426His-bundle pacing in CHF-patients with narrow QRS and chronic AF using dual-chamber ICD - an upgrade from single-chamber to dual-chamber ICD

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A Ciesielski ◽  
A Slawuta ◽  
K Boczar ◽  
A Zabek ◽  
B Malecka ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Nyha Class ◽  
Clinical Status ◽  
Chronic Atrial Fibrillation ◽  
P Value ◽  
Dual Chamber ◽  
Icd Implantation ◽  
Single Chamber ◽  
His Bundle

Abstract A single-chamber ICD is a standard method for primary SCD prophylaxis. In patients with chronic atrial fibrillation it dose not contribute to the regularization of heart rate, which is crucial for proper treatment. The aim of our study was to assess the efficacy of direct His-bundle pacing in patients with congestive heart failure and chronic atrial fibrillation using upgrade from single chamber to dual-chamber ICD. Methods The study population included 21 patients with CHF and chronic AF implanted primarily with single chamber ICD with etablished pharmacotherapy and stable clinical status. Results The echocardiography measurements at baseline and during ollow-up were presented in the table: Table 1 Baseline Follow-up p-value LVEDD (ms) 67.7±10.7 64.5±8.6 <0.05 EF (%) 27.0±4.8 33.2±6.9 <0.05 NYHA class 2.8±0.6 1.9±0,5 <0.05 During short 4-months of follow-up the mean values of EF and LV dimensions significantly improved. This was also accompanied by functional status improvement. Conclusions His-bundle-based pacing in CHF-chronic AF patients contributes to significant echocardiographic and clinical improvement. Standard single-chamber ICD implantation in CHF-chronic AF patients yields only SCD prevention without influence on remodeling process.

P1239His-bundle pacing in CHF-patients with narrow QRS and chronic AF using dual-chamber ICD

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A Slawuta ◽  
K Boczar ◽  
A Zabek ◽  
A Ciesielski ◽  
J Hiczkiewicz ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Congestive Heart Failure ◽  
Dual Chamber ◽  
His Bundle ◽  
His Bundle Pacing ◽  
Narrow Qrs ◽  
Group A ◽  
Group B

Abstract The heart rate regularization is crucial for proper treatment of patients with atrial fibrillation and congestive heart failure. The standard resynchronization can be applied, but in patients with narrow QRS this procedure is of no use. The aim of our study is to assess the efficacy of direct His-bundle pacing in patients with congestive heart failure and chronic atrial fibrillation using dual chamber ICD implanted for prevention of sudden cardiac death. Methods The study population included 78 patients with CHF and chronic AF: group A - 56 pts treated with direct His-bundle pacing using atrial port of dual chamber ICD and group B - 22 patients implanted with single chamber ICD as recommended by the guidelines. The patients in group B constituting clinical controls were derived from the Heart Failure Outpatients Clinic with established clinical status and pharmacotherapy. Results The demographic data, clinical characteristics and echocardiography measurements at baseline and during follow-up were presented in the table: Table 1 Group A Group B P value Age (years) 69.7±6.9 66.7±11.3 n.s. Sex (% of male sex) 84.0 86.4 n.s. Ventricular pacing (%) – 46.3±31.2 – His-bundle pacing (%) 81.7±9.2 – – pre post pre post pre vs. post LVEDD (mm) 66.9±4.9 59.9±4.7 64.8±8.0 64.7±8.1 <0.01 n.s. EF (%) 29.6±3.8 43.6±5.9 28.1±6.1 28.8±7.3 <0.01 n.s. NYHA class 2.7±0.6 1.4±0.6 2.5±0.6 2.0±0.2 <0.05 n.s. B-blocker dose (metoprolol equivalent dose) 104.6±41.6 214.3±82.6 78.3±56.6 103.1±49.2 <0.001 <0.05 During 12-months of follow-up the mean values of NYHA functional class, EF and LV dimensions did not change in group B but significantly improved in group A. The physiological His-bundle based pacing enabled optimal beta-blocker dosing. The studied groups had no tachyarrhythmia at baseline so the presumable atrial fibrillation-related harm depends on the rhythm irregularity. Conclusions His-bundle-based pacing in CHF-chronic AF patients contributes to significant echocardiographic and clinical improvement. Standard single-chamber ICD implantation in CHF-chronic AF patients yields only SCD prevention without influence on remodeling process. The CHF-patients with narrow QRS and chronic AF benefit from substantially higher beta-blockade which can be instituted in His-bundle pacing group.

Dual chamber cardioverter-defibrillator used for His bundle pacing in patient with chronic atrial fibrillation

2015 ◽  
Vol 182 ◽  
pp. 395-398 ◽  
Author(s):  
Agnieszka Sławuta ◽  
Dariusz Biały ◽  
Joanna Moszczyńska-Stulin ◽  
Piotr Berkowski ◽  
Paweł Dąbrowski ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Chronic Atrial Fibrillation ◽  
Dual Chamber ◽  
Cardioverter Defibrillator ◽  
His Bundle ◽  
His Bundle Pacing

scholarly journals Troubleshooting Programming of Conduction System Pacing

2021 ◽  
Vol 10 (2) ◽  
pp. 85-90
Author(s):  
Elise Bakelants ◽  
Haran Burri
Keyword(s):  
Sinus Rhythm ◽  
Heart Rhythm ◽  
Conduction System ◽  
Atrial Arrhythmia ◽  
Dual Chamber ◽  
Single Chamber ◽  
His Bundle ◽  
His Bundle Pacing ◽  
Device Programming

Conduction system pacing (CSP) comprises His bundle pacing and left bundle branch area pacing and is rapidly gaining widespread adoption. Effective CSP not only depends on successful system implantation but also on proper device programming. Current implantable impulse generators are not specifically designed for CSP. Either single chamber, dual chamber or CRT devices can be used for CSP depending on the underlying heart rhythm (sinus rhythm or permanent atrial arrhythmia) and the aim of pacing. Different programming issues may arise depending on the device configuration. This article aims to provide an update on practical considerations for His bundle and left bundle branch area pacing programming and follow-up.

Abstract 17557: Programmed Lower Rate Limit in Cardiac Resynchronization Therapy Defibrillators: Is There One Best Approach?

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Brian Olshansky ◽  
Mark Richards ◽  
Arjun D Sharma ◽  
Paul W Jones ◽  
Nicholas Wold ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Survival Benefit ◽  
Chronic Atrial Fibrillation ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy ◽  
Dual Chamber ◽  
The Social ◽  
Social Security Death Index ◽  
Rate Limit

Introduction: Recent remote follow-up data analysis suggests that Lower Rate Limit (LRL) programming at 40 beats per minute (bpm) is associated with lower mortality than higher LRL in patients receiving cardiac resynchronization defibrillators (CRT-d) devices. Purpose: We evaluated: 1. if LRL programming in CRT-d devices is based on implanting center or if it varies from patient-to-patient within centers and 2. if LRL programming is associated with survival. Method: The ALTITUDE remote follow-up database was analyzed for dual-chamber CRT-d devices implanted 2006-2011. LRL programming near implant was assessed. Patients were included if LRL remained constant during follow-up. Centers were included with >25 implants. Mortality was determined from the Social Security Death Index. Results: Of 64,482 patients receiving CRT-d devices (not in chronic atrial fibrillation), 56,501 were from centers implanting >25 devices. Of these, 4,683 were implanted in centers where most patients (>75%) received the same LRL (homogeneous); 51,818 were implanted in centers with variable LRL programming (heterogeneous). No difference in overall survival existed between the two approaches to LRL programming. However, in centers that varied LRL programming, LRL<60 bpm was associated with better 5-year survival (p<0.001) (figure). Conclusion: Most patients in the ALTITUDE database received CRT-D devices from centers that vary LRL programming. At these centers, LRL <60 bpm programming is associated with better survival but the mechanism of benefit is unknown. Alternatively, LRL <60 bpm programming for all patients does not confer survival benefit.

Abstract 17261: Maintenance of Sinus Rhythm After His Bundle Pacing and AV Nodal Ablation in Patients With Recurrent Atrial Fibrillation After Catheter Ablation

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Amrish Deshmukh ◽  
Puspha Khanal ◽  
Amlish Gondal ◽  
Mary Romanyshyn ◽  
Pramod Deshmukh
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Sinus Rhythm ◽  
Cardiac Resynchronization ◽  
Atrial Remodeling ◽  
Clinical Recurrence ◽  
His Bundle ◽  
His Bundle Pacing ◽  
Recurrent Atrial Fibrillation

Background: Catheter ablation (CA) is the most effective means of rhythm control for atrial fibrillation (AF) but is not curative. Irregular and rapid ventricular activation by AF begets AF. Cardiac resynchronization and atrioventricular nodal (AVN) ablation have been associated with favorable atrial remodeling and spontaneous reversion to sinus rhythm in patients with longstanding atrial fibrillation. Hypothesis: We hypothesized that in patients with longstanding persistent AF who had failed CA, AVN ablation and His bundle pacing (HBP) may improve maintenance of sinus rhythm. Methods and Results: A total of 13 patients (5 female, age 69±8.7 years, 8 with HFrEF, BMI 29 ±5 kg/m 2 ,LVEF 38±15%, NYHA 3±0.6) underwent simultaneous AVN ablation and HBP an average of 531 days (Range 1-2158 days) after CA for AF with recurrent AF. Prior to AVN ablation and HBP these patients had a median 9-year history of AF (IQR: 5-15 years) with a median of 2 prior cardioversions (IQR: 1-4) and 2 prior CA. All patients had failed at least 1 antiarrhythmic drug. In 3 patients HBP induced cardiac resynchronization of pre-existing bundle branch block and in 8 patients HBP was fused with ventricular pacing to optimize QRS duration. 12 of 13 patients had an atrial lead. All patients underwent cardioversion at the time of the procedure. In a median of follow up of 21 months (IQR:4-74 months), 7 of the 13 patients (54%) had no device detected or clinical recurrence of AF. In follow up LVEF increased to 46±12.7% and NYHA class to 2 ±0.2. Of patients with recurrence, 3 underwent CA and had no recurrence of AF in subsequent follow up. Conclusion: In patients with advanced longstanding persistent AF, a strategy of AVN ablation and HBP allowed for ventricular rate control with a narrow QRS. This approach resulted in a lower than expected rate of AF recurrence.

Electrical characteristics of pacing different portions of the His bundle in bradycardia patients

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_2) ◽  
pp. ii27-ii35
Author(s):  
Yiran Hu ◽  
Min Gu ◽  
Wei Hua ◽  
Hongxia Niu ◽  
Hui Li ◽  
...  
Keyword(s):  
Wave Amplitude ◽  
Electrical Characteristics ◽  
Normal Range ◽  
Tricuspid Valve Regurgitation ◽  
His Bundle ◽  
His Bundle Pacing ◽  
Pacing Mode ◽  
Echocardiographic Assessment ◽  
R Wave Amplitude

Abstract Aims His-bundle pacing (HBP) can be achieved in either atrial-side HBP (aHBP) or ventricular-side HBP (vHBP). The study compared the pacing parameters and electrophysiological characteristics between aHBP and vHBP in bradycardia patients. Methods and results Fifty patients undergoing HBP implantation assisted by visualization of the tricuspid valvular annulus (TVA) were enrolled. The HBP lead position was identified by TVA angiography. Twenty-five patients were assigned to undergo aHBP and compared with 25 patients who underwent vHBP primarily in a prospective and randomized fashion. Pacing parameters and echocardiography were routinely assessed at implant and 3-month follow-up. His-bundle pacing was successfully performed in 45 patients (90% success rate with 44.4% aHBP and 55.6% vHBP). The capture threshold was lower in vHBP than aHBP at implant (vHBP: 1.1 ± 0.5 vs. aHBP: 1.4 ± 0.4 V/1.0 ms, P = 0.014) and 3-month follow-up (vHBP: 0.8 ± 0.4 vs. aHBP: 1.7 ± 0.8 V/0.4 ms, P &lt; 0.001). The R-wave amplitude was higher in vHBP than in aHBP at implant (vHBP: 4.5 ± 1.4 vs. aHBP: 2.0 ± 0.8 mV, P &lt; 0.001) and at 3-month follow-up (vHBP: 4.4 ± 1.5 vs. aHBP: 1.8 ± 0.7 mV, P &lt; 0.001). No procedure-related complications and aggravation of tricuspid valve regurgitation were observed in most patients and echocardiographic assessment of cardiac function remained in the normal range in all patients during the follow-up. Conclusion This study demonstrates that vHBP features a low and stable pacing capture threshold and high R-wave amplitude, suggesting better pacing mode management and battery longevity can be achieved by HBP in the ventricular side.

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