His-Optimized Cardiac Resynchronization Therapy to Maximize Electrical Resynchronization
Why the study?
QRS narrowing achieved by His bundle pacing is not always optimal, prompting investigation into whether sequential His bundle and left ventricular pacing could maximize electrical resynchronization.
Does His-Optimized CRT (HOT-CRT) improve electrical resynchronization and clinical/echocardiographic outcomes in patients referred for CRT?
Population
27 patients referred for CRT
Comparison
HOT-CRT vs baseline, HBP, and biventricular pacing
Design
Feasibility cohort study
Follow-up
Mean 14±10 months
Authors
Discussion
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Member takes
Implication
May support HOT-CRT consideration in advanced HF; leaves open superiority over biventricular pacing in randomized trials.
Structured PICO
Does His-Optimized CRT (HOT-CRT) improve electrical resynchronization and clinical/echocardiographic outcomes in patients referred for CRT?
P
Population
27 patients referred for cardiac resynchronization therapy (CRT) with left bundle branch block (n=17), intraventricular conduction defect (n=5), or right ventricular pacing (n=5). The successful cohort (n=25) had a mean age of 72±15 years, 23 men, and 21 with ischemic etiology.
I
Intervention
His-Optimized Cardiac Resynchronization Therapy (HOT-CRT), consisting of permanent His bundle pacing (HBP) followed by left ventricular (LV) pacing at a delay equal to the His-ventricular interval.
C
Comparator
Within-subject comparisons to baseline intrinsic conduction, standard biventricular pacing, and His bundle pacing alone.
O
Outcome
QRS duration (electrical resynchronization)surrogate
HOT-CRT significantly improves electrical resynchronization and left ventricular ejection fraction compared to traditional biventricular pacing in patients with advanced heart failure.
Cite This Study
Vijayaraman et al. (2019) studied this question.