Permanent nonselective His bundle pacing in an adult with L-transposition of the great arteries and complete AV block

Abstract Background His-bundle pacing (HBP) alone may become an alternative to conventional cardiac resynchronization therapy (CRT) utilizing right ventricular apical (RVA) and left ventricular (LV) pacing (BiVRVA+LV) in selected patients, but the effects of CRT utilizing HBP and LV pacing (BiVHB+LV) on cardiac resynchronization and heart failure (HF) are unclear. Case summary We presented two patients with inotrope-dependent end-stage HF in whom the upgrade from conventional BiVRVA+LV to BiVHB+LV pacing by the addition of a lead for HBP improved their HF status. Patient 1 was a 32-year-old man with lamin A/C cardiomyopathy, atrial fibrillation, and complete atrioventricular (AV) block. Patient 2 was a 70-year-old man with ischaemic cardiomyopathy complicated by AV block and worsening of HF resulting from ablation for ventricular tachycardia storm. The HF status of both patients improved dramatically following the upgrade from BiVRVA+LV to BiVHB+LV pacing. Discussion End-stage HF patients suffer from diffuse intraventricular conduction defect not only in the LV but also in the right ventricle (RV). The resulting dyssynchrony may not be sufficiently corrected by conventional BiVRVA+LV pacing or HBP alone. Right ventricular apical pacing itself may also impair RV synchrony. An upgrade to BiVHB+LV pacing could be beneficial in patients who become non-responsive to conventional BiV pacing as the His–Purkinje conduction defect progresses.

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His Bundle Pacing Improves LV Diastolic Function in Patients with Heart Failure with Preserved Systolic Function

10.22541/au.163573049.97477108/v1 ◽

2021 ◽

Author(s):

Bengt Herweg ◽

Dipayon Roy ◽

Allan Welter-Frost ◽

Cody Williams ◽

Arzu Ilercil ◽

...

Keyword(s):

Heart Failure ◽

Diastolic Function ◽

Patient Population ◽

Systolic Function ◽

Systolic Dysfunction ◽

Left Ventricular ◽

Av Block ◽

His Bundle ◽

His Bundle Pacing ◽

Lv Systolic Function

Cardiac resynchronization therapy (CRT) is highly effective for patients with left bundle branch block (LBBB), heart failure and left ventricular (LV) systolic dysfunction. Chronic right ventricular (RV) apical pacing is associated with pacing-induced cardiomyopathy and can be associated with exertional intolerance. The goal of this study was to assess the acute hemodynamic effects of His-bundle Pacing (HBP) compared to RV apical pacing in absence of LV systolic dysfunction in patients with exertional intolerance. Our patient population consisted of 5 patients with preserved LV systolic function and complete AV block. All five patients suffered from exertional intolerance in spite of preserved LV systolic function. At the time of generator change, all patients underwent implantation of a HBP lead. The QRS duration decreased from 179±13 ms with RVP to 113±6 with HBP (p < 0.001). Compared to RVP, HBP was associated with significantly longer diastolic filling time and improved septal early diastolic myocardial relaxation velocity (E’). Four of five patients noted acutely improved exertional dyspnea. In patients with AV block, exertional intolerance and preserved LV systolic function who are treated with chronic RV apical pacing, HBP may improve acute diastolic function and symptoms of exertional intolerance when compared to RV apical pacing. Randomized controlled trials are warranted to explore the effects of conduction system pacing in this unique patient population.

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