P1827Dual chamber ICD implantation using His-bundle pacing in CHF-patients with narrow QRS and chronic AF can reverse cardiac remodeling

2018 ◽  
Vol 39 (suppl_1) ◽  
Author(s):  
A Slawuta ◽  
K Boczar ◽  
A Zabek ◽  
P Vijayaraman ◽  
B Malecka ◽  
...  
Keyword(s):  
Cardiac Remodeling ◽  
Icd Implantation ◽  
His Bundle ◽  
His Bundle Pacing ◽  
Narrow Qrs ◽  
Reverse Cardiac Remodeling

scholarly journals P1013Cardiac remodeling reversed by His-bundle pacing in CHF-patients with narrow QRS and chronic AF undergoing ICD implantation

EP Europace ◽  
2017 ◽  
Vol 19 (suppl_3) ◽  
pp. iii215-iii215
Author(s):  
A. Slawuta ◽  
K. Boczar ◽  
A. Zabek ◽  
J. Gajek ◽  
J. Lelakowski ◽  
...  
Keyword(s):  
Icd Implantation ◽  
His Bundle ◽  
His Bundle Pacing ◽  
Narrow Qrs

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

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.

scholarly journals Atrial and atrioventricular resynchronization the benefit of bachmanns bundle and his bundle pacing

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
P Wolff ◽  
P Strozik ◽  
A Gajek ◽  
A Ciesielski ◽  
A Slawuta ◽  
...  
Keyword(s):  
Heart Failure ◽  
Functional Status ◽  
Conduction Delay ◽  
Qrs Complex ◽  
His Bundle ◽  
His Bundle Pacing ◽  
Narrow Qrs ◽  
Patients With Heart Failure ◽  
Narrow Qrs Complex ◽  
Bachmann’S Bundle

Abstract   The current treatment of patients with heart failure and concomitant atrioventricular conduction delay is difficult. Recommendations indicate the possibility to use the classic resynchronization but in the presence of narrow QRS-complex such approach could be even harmful. Without a sufficient LBBB morphology as indication for classical CRT, those patients would lose their narrow QRS complex with negative consequences for the hearts functional status. A new therapeutic option for those patients to re-establish the physiological atrioventricular mechanical sequence is the permanent His-bundle pacing (pHBP). Advantages like physiological activation sequence of the ventricular myocardium, less affected by AF compared to classical CRT and reversal of mitral regurgitation should be enumerated to show it's beneficial effect. Additionally the use of Bachmann's-bundle pacing can correct the prolonged interatrial conduction thus further contribute to the echocardiographic and clinical improvement. The aim of the study is to assess the influence of Bachmann's-bundle pacing and His-bundle pacing on the reversed remodeling of the heart in patients with heart failure and atrioventricular block. The study group included 21 patients (7 women and 14 men) undergoing cardiac resynchronization using Bachmann's-bundle pacing and permanent His-bundle pacing from LV channel for atrioventricular conduction delay. All the patients had narrow QRS-complex which prevented us to use classic resynchronization. 13 CRT-D and 8 CRT-P devices were implanted according to the ejection fraction and ventricular arrhythmia risk assessment. In all patients the direct His-bundle pacing was successfully achieved, selective in 17 and non-selective in 4 patients. The mean follow-up (FU) period was 8.8 months (1–26 months). The echocardiographic, clinical and ECG results are presented in the table 1. Conclusions 1. The correction of atrioventricular and interatrial conduction delay resulting in improvement of atrioventricular mechanical coupling can contribute to the reversed remodeling of the heart. 2. This also improves the patient's functional status. 3. In some patients this approach could lead to the normalization of echocardiographic parameters of the left ventricle. Funding Acknowledgement Type of funding source: None

Pacing parameters and success rates of permanent His-bundle pacing in patients with narrow QRS: a single-centre experience

EP Europace ◽  
2018 ◽  
Vol 21 (5) ◽  
pp. 763-770 ◽  
Author(s):  
Lan Su ◽  
Shengjie Wu ◽  
Songjie Wang ◽  
Zhengxian Wang ◽  
Fangyi Xiao ◽  
...  
Keyword(s):  
Success Rates ◽  
Single Centre ◽  
His Bundle ◽  
His Bundle Pacing ◽  
Narrow Qrs ◽  
Single Centre Experience

Biventricular Versus His Bundle Pacing After Atrioventricular Node Ablation in Heart Failure Patients With Narrow QRS

2020 ◽  
Author(s):  
David Žižek ◽  
Bor Antolič ◽  
Anja Zupan Mežnar ◽  
Dinko Zavrl Džananović ◽  
Matevž Jan ◽  
...  
Keyword(s):  
New York ◽  
Atrioventricular Node ◽  
Heart Association ◽  
Left Ventricular ◽  
Ventricular Rate ◽  
Complication Rates ◽  
His Bundle ◽  
His Bundle Pacing ◽  
Narrow Qrs ◽  
New York Heart Association

Abstract Background His bundle pacing (HBP) is a physiological alternative to biventricular (BiV) pacing. Our goal was to compare short-term results of both pacing approaches in ventricular rate refractory atrial fibrillation (AF) patients who underwent atrioventricular node ablation (AVNA).Methods Consecutive symptomatic AF patients with moderately reduced left ventricular (LV) ejection fraction (EF ≥35% and <50%) and narrow QRS (≤120ms) who received HBP in conjunction with AVNA were compared to historical BiV pacing controls. Electrocardiographic, echocardiographic, and clinical data at baseline and 6 months after the procedure were assessed. Results Among 24 patients (age 68.8 ± 6.5 years, 50% female, EF 39.6 ± 4%, QRS 95 ± 10ms) who underwent AVNA, 12 received BiV pacing and 12 HBP. Both pacing modalities had similar acute procedure-related success and complication rates. HBP was superior to BiV pacing in terms of post-implant QRS duration, implantation fluoroscopy times, reduction of LV volumes (EDV 127 (86 – 150) ml vs. 146 (121 – 190) ml, P = 0.101; ESV 64 (46 – 81) ml vs. 90 (75 – 123) ml, P = 0.008) and increase in LVEF (46 (41 – 55) % vs. 38 (35 – 42) %, P = 0.005). However, improvement of the New York Heart Association class was similar in both groups.Conclusions In ventricular rate refractory AF patients with moderately reduced EF and narrow QRS undergoing AVNA, HBP could be a conceivable alternative to BiV pacing. Further prospective studies are warranted to address the outcomes between both “ablate and pace” strategies.

scholarly journals Biventricular versus His bundle pacing after atrioventricular node ablation in heart failure patients with narrow QRS

2021 ◽  
pp. 1-9
Author(s):  
David Žižek ◽  
Bor Antolič ◽  
Anja Zupan Mežnar ◽  
Dinko Zavrl-Džananović ◽  
Matevž Jan ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrioventricular Node ◽  
Heart Failure Patients ◽  
His Bundle ◽  
His Bundle Pacing ◽  
Narrow Qrs
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