scholarly journals Electrode Model and Simulation of His- Bundle Pacing for Cardiac Resynchronization Therapy

2020 ◽  
Vol 6 (3) ◽  
pp. 555-558
Author(s):  
Domenic Pascual ◽  
Matthias Heinke ◽  
Reinhard Echle ◽  
Johannes Hörth
Keyword(s):  
Cardiac Resynchronization Therapy ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Left Ventricular Ejection ◽  
Resynchronization Therapy ◽  
Electrical Field ◽  
His Bundle ◽  
His Bundle Pacing ◽  
Surface Ecg ◽  
Electrical Pacing

AbstractA disturbed synchronization of the ventricular contraction can cause a highly developed systolic heart failure in affected patients with reduction of the left ventricular ejection fraction, which can often be explained by a diseased left bundle branch block (LBBB). If medication remains unresponsive, the concerned patients will be treated with a cardiac resynchronization therapy (CRT) system. The aim of this study was to integrate His-bundle pacing into the Offenburg heart rhythm model in order to visualize the electrical pacing field generated by His-Bundle-Pacing. Modelling and electrical field simulation activities were performed with the software CST (Computer Simulation Technology) from Dessault Systèms. CRT with biventricular pacing is to be achieved by an apical right ventricular electrode and an additional left ventricular electrode, which is floated into the coronary vein sinus. The non-responder rate of the CRT therapy is about one third of the CRT patients. His- Bundle-Pacing represents a physiological alternative to conventional cardiac pacing and cardiac resynchronization. An electrode implanted in the His-bundle emits a stronger electrical pacing field than the electrical pacing field of conventional cardiac pacemakers. The pacing of the Hisbundle was performed by the Medtronic Select Secure 3830 electrode with pacing voltage amplitudes of 3 V, 2 V and 1,5 V in combination with a pacing pulse duration of 1 ms. Compared to conventional pacemaker pacing, His-bundle pacing is capable of bridging LBBB conduction disorders in the left ventricle. The His-bundle pacing electrical field is able to spread via the physiological pathway in the right and left ventricles for CRT with a narrow QRS-complex in the surface ECG.

scholarly journals Upgrade of cardiac resynchronization therapy by utilizing additional His-bundle pacing in a patient with lamine A/C cardiomyopathy: an autopsy case report

2021 ◽  
Author(s):  
Masako Baba ◽  
Kentaro Yoshida ◽  
Osamu Igawa ◽  
Masayoshi Yamamoto ◽  
Akihiko Nogami ◽  
...  
Keyword(s):  
Cardiac Resynchronization Therapy ◽  
Present Report ◽  
Biventricular Pacing ◽  
Scar Tissue ◽  
Left Ventricular ◽  
Conduction System ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy ◽  
His Bundle ◽  
His Bundle Pacing

Abstract Background A number of heart failure patients (HF) do not fully benefit from cardiac resynchronization therapy (CRT). Although His bundle pacing (HBP) have been developed as an alternative strategy, its role for treating advanced cardiomyopathy remains unclear. Case summary We previously reported a patient with lamin A/C cardiomyopathy (Eur Heart J Case Rep. 2020; 4:1-9). He had turned non-response to conventional biventricular pacing (BVP), and an upgrade to CRT combining para-His bundle pacing (HBP) and left ventricular (LV) pacing had markedly improved his HF status. In the present report, we assessed the autopsy and histological findings of this patient. A histological examination of both the LV and right ventricular (RV) apex pacing regions exhibited extensive scarring. Although a distinct conduction system was not identified in the alternative para-HBP region, the RV endocardium had more viable myocytes in this region. Discussion In patients with advanced cardiomyopathy accompanied by extensive fibrosis, RV apex pacing, delivered from scar tissue, can render conventional BVP ineffective. Additionally, HBP alone can not provide adequate resynchronization under the presence of diffuse injury of the His-Purkinje system. In these circumstances, combined para-HB and LV pacing may facilitate electrical and mechanical resynchronization of the ventricles and may be attributed to favourable CRT response in advanced HF, even if para-HBP fails to directly capture the conduction system.

scholarly journals His-optimized cardiac resynchronization therapy in a patient with heart failure and right bundle branch block: a case report

2021 ◽  
Vol 5 (8) ◽  
Author(s):  
Dmytro Volkov ◽  
Dmytro Lopin ◽  
Stanislav Rybchynskyi ◽  
Dmytro Skoryi
Keyword(s):  
Heart Failure ◽  
Cardiac Resynchronization Therapy ◽  
Right Bundle Branch Block ◽  
Clinical Status ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Left Ventricular Ejection ◽  
Resynchronization Therapy ◽  
Bundle Branch Block ◽  
Ventricular Ejection Fraction

Abstract Background  Cardiac resynchronization therapy (CRT) is an option for treatment for chronic heart failure (HF) associated with left bundle branch block (LBBB). Patients with HF and right bundle branch block (RBBB) have potentially worse outcomes in comparison to LBBB. Traditional CRT in RBBB can increase mortality and HF deterioration rates over native disease progression. His bundle pacing may improve the results of CRT in those patients. Furthermore, atrioventricular node ablation (AVNA) for rate control in atrial fibrillation (AF) can be challenging in patients with previously implanted leads in His region. Case summary  We report the case of 74-year-old gentleman with a 5-year history of HF, permanent AF with a rapid ventricular response, and RBBB. He was admitted to the hospital with complaints of severe weakness and shortness of breath. Left ventricular ejection fraction (LVEF) was decreased (41%), right ventricle (RV) was dilated (41 mm), and QRS was prolonged (200 ms) with RBBB morphology. The patient underwent His-optimized CRT with further left-sided AVNA. As a result, LVEF increased to 51%, RV dimensions decreased to 35 mm with an improvement of the clinical status during a 6-month follow-up. Discussion  Patients with AF, RBBB, and HF represent the least evaluated clinical subgroup of individuals with less beneficial clinical outcomes according to CRT studies. Achieving the most effective resynchronization could require pacing fusion from sites beyond traditional with the intention to recruit intrinsic conduction pathways. This approach can be favourable for reducing RV dilatation, improving LVEF, and maximizing electrical resynchronization.

Abstract 14932: Effects of Cardiac Resynchronization Therapy in Ischemic Cardiomyopathy Patients by Revascularization Procedures in MADIT-CRT

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Mustafa Husaini ◽  
Yitschak Biton ◽  
Scott McNitt ◽  
Wojciech Zareba ◽  
Arthur J Moss ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiac Resynchronization Therapy ◽  
Risk Reduction ◽  
Ischemic Cardiomyopathy ◽  
Significant Risk ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Left Ventricular Ejection ◽  
Resynchronization Therapy ◽  
Revascularization Procedures

Background: The Multicenter Automatic Defibrillator Implantation Trial with Cardiac Resynchronization Therapy (MADIT-CRT) showed that patients with ischemic cardiomyopathy (ICM) had similar reductions in clinical events with implanted CRT-D vs. ICD-only when compared to patients with non-ischemic cardiomyopathy (NICM). Frequency of revascularizations may serve as a surrogate for severity of coronary artery disease in patients with ICM and severely reduced left ventricular ejection fraction. However, it is unknown whether the number of revascularizations plays a role in clinical outcomes in ICM patients implanted with CRT-D vs. ICD-only. Methods: Using a multivariable analysis of MADIT-CRT data, we evaluated the effect of CRT-D vs. ICD-only on combined heart failure (HF) or death and combined ventricular tachycardia (VT), ventricular fibrillation (VF) or death in ICM patients by the number of pre-enrollment revascularizations (1 or ≥ 2 revascularizations) compared to those with no need for revascularization. Follow-up over a median period of 5.6 years for HF/death and 4.0 years for VT/VF/death was assessed among 1374 ICM patients with a Left Bundle Branch Block (LBBB). Results: There was a significant and similar risk reduction with CRT-D vs. ICD-only in HF/death in all three sub-groups: ICM with no need for revascularization (HR 0.45 [0.26-0.80]; p < 0.006), ICM with one revascularization (HR 0.46 [0.31-0.69]; p <0.001), and ICM with 2 or more revascularization (HR 0.50 [0.30-0.84]; p = 0.008). However, significant risk reduction of VT/VF/death with CRT-D vs. ICD-only was only observed in patients with no need for revascularization (HR 0.52 [0.30-0.89]; p = 0.017), less so in those with ICM with one revascularization (HR 0.72 [0.49-1.06]; p = 0.10), and no reduction was seen in those with ICM with 2 or more revascularization (HR 0.94 [0.54-1.62]; p = 0.81). Conclusions: In ischemic cardiomyopathy patients, CRT-D vs. ICD-only is associated with a significant risk reduction in heart failure events or death irrespective of the frequency of pre-enrollment revascularization procedures; however, the benefit of CRT-D vs. ICD-only to reduce ventricular tachyarrhythmias is attenuated with the increasing number of revascularization procedures.

scholarly journals His bundle pacing after failure of cardiac resynchronization therapy: a case study

2020 ◽  
Vol 48 (5) ◽  
pp. 030006052092349
Author(s):  
Katarína Koščová ◽  
Milan Chovanec ◽  
Jan Petrů ◽  
Lucie Šedivá ◽  
Libor Dujka ◽  
...  
Keyword(s):  
Cardiac Resynchronization Therapy ◽  
Cardiac Pacing ◽  
Cardiac Resynchronization ◽  
Ventricular Pacing ◽  
Resynchronization Therapy ◽  
Bundle Branch Block ◽  
Right Ventricular Pacing ◽  
His Bundle ◽  
His Bundle Pacing

His bundle pacing is a relatively new method of cardiac pacing. This method is used in patients with atrioventricular block to prevent heart failure associated with right ventricular pacing, and in patients with bundle branch block and cardiomyopathy. We report a patient with cardiomyopathy and left bundle branch block with failure of cardiac resynchronization therapy. Permanent His bundle pacing was associated with clinical improvement and improvement of parameters of cardiac function.

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