Key result
His bundle plus LV pacing links to superior cardiac output versus BiV or RVP in HF and AF.
Why the study?
Little is known regarding the optimal programming method for His bundle-paced CRT systems to achieve the best cardiac output.
Does His bundle pacing combined with left ventricular pacing improve cardiac output compared to other pacing modalities in patients with heart failure, atrial fibrillation, and bundle branch block?
Observational (n=21)
Does His bundle pacing combined with left ventricular pacing improve cardiac output compared to other pacing modalities in patients with heart failure, atrial fibrillation, and bundle branch block?
In patients with heart failure, atrial fibrillation, and bundle branch block undergoing CRT, His bundle pacing combined with left ventricular pacing provides the best acute echocardiographic hemodynamic response compared to other pacing configurations.
HBP+LV pacing was associated with superior acute hemodynamics in HF with AF; hypothesis-generating for CRT optimization, needs randomized confirmation.
BACKGROUND: His bundle pacing (HBP) has proved to be a valuable alternative enabling the physiological activation of cardiac contraction in cardiac resynchronization therapy (CRT). At present, however, little is known about the optimal method of programming of the His bundle-paced CRT systems in terms of achieving the best cardiac output. AIM: The aim of this study was to evaluate the impact of cardiac resynchronization therapy with conduction system pacing (CRT+CSP) on echo-based hemodynamic parameters in the early post-operative measurements. METHODS: The study enrollment criteria included: permanent atrial fibrillation, heart failure and bundle branch block. All patients underwent implantation of CRT + HBP. During the post-operative phase, we aimed to optimize HOT-CRT settings in order to achieve the greatest cardiac output assessed by complex echocardiographic measurements. RESULTS: The study included 21 patients, mean age 71.2 (6.3) years, predominantly men (71.4%) with non-ischemic cardiomyopathy 62%. All patients had heart failure with NYHA functional class III and IV (81%). Mean left ventricular ejection fraction was 27.5 (9.7%). The mean duration of the QRS complex was 148.8 ms. The effects of resynchronization pacing: HBP alone, HBP with left ventricular pacing, HBP with biventricular pacing (BiV) and BiV without HBP were analyzed consecutively. HBP combined with left ventricular pacing demonstrated the best hemodynamic response. CONCLUSION: His bundle pacing coupled with LV pacing proved to be the most advantageous pacing program setting with regard to cardiac output. Moreover, it performed better than biventricular pacing and significantly better than RV pacing.
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Boczar et al. (2023) conducted an observational in Heart failure with permanent atrial fibrillation and bundle branch block (n=21). His bundle pacing combined with left ventricular pacing vs. HBP alone, HBP with biventricular pacing, biventricular pacing without HBP, and RV pacing was evaluated on Cardiac output assessed by complex echocardiographic measurements. His bundle pacing coupled with left ventricular pacing provided the best cardiac output compared to biventricular and right ventricular pacing in patients with heart failure and atrial fibrillation.
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