Key result
Simultaneous His-bundle and left ventricular pacing improved stroke volume (88±31 mL vs 58±23 mL for AAI; P<0.001) and other hemodynamic indexes regardless of atrioventricular delay settings.
Why the study?
Does simultaneous His-bundle and left ventricular pacing improve acute hemodynamics compared to standard pacing configurations in patients with systolic heart failure and LBBB?
Does simultaneous His-bundle and left ventricular pacing improve acute hemodynamics compared to standard pacing configurations in patients with systolic heart failure and LBBB?
p-value: p=<0.001
Simultaneous His-bundle and left ventricular pacing improves acute hemodynamics regardless of atrioventricular delay, highlighting the importance of intrinsic right ventricular conduction in optimizing CRT.
Associated with acute hemodynamic gains in systolic HF with LBBB; hypothesis-generating for His-bundle-inclusive CRT, needing randomized confirmation.
BACKGROUND: Previous studies have investigated the role of intrinsic conduction in optimizing cardiac resynchronization therapy. We investigated the role of fusing pacing-induced activation and intrinsic conduction in cardiac resynchronization therapy by evaluating the acute hemodynamic effects of simultaneous His-bundle (HIS) and left ventricular (LV) pacing. METHODS AND RESULTS: We studied 11 patients with systolic heart failure and left bundle-branch block scheduled for cardiac resynchronization therapy implantation. On implantation, LV pressure-volume data were determined via conductance catheter. Standard leads were placed in the right atrium, at the right ventricular apex, and in a coronary vein. An additional electrode was temporarily positioned in the HIS. The following pacing configurations were systematically assessed: standard biventricular (right ventricular apex+LV), LV-only, HIS, simultaneous HIS and LV (HIS+LV). Each configuration was compared with the AAI mode at multiple atrioventricular delays (AVD). In comparison with the AAI, right ventricular apex+LV and LV-only pacing resulted in improved stroke volume (85±32 mL and 86±33 mL versus 58±23 mL; P<0.001), stroke work, maximum pressure derivative, and systolic dyssynchrony at individually optimized AVD. The optimal AVD was close to the P-H interval in the majority of patients. By contrast, HIS-LV pacing improved hemodynamic indexes at all AVD (stroke volume >76 mL at all fixed intervals and 88±31 mL at optimal interval; all P<0.001). CONCLUSIONS: Standard right ventricular apex+LV and LV-only pacing enhanced systolic function and LV synchrony at individually optimized AVD close to the measured intrinsic P-H interval. By contrast, HIS+LV pacing yielded improvements, regardless of AVD setting. These findings support the hypothesis of the crucial role of intrinsic right ventricular conduction in optimal cardiac resynchronization therapy delivery.
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Padeletti et al. (2016) studied Systolic heart failure and left bundle-branch block (n=11). Simultaneous His-bundle and left ventricular pacing vs. AAI mode, standard biventricular pacing, and LV-only pacing was evaluated on Acute hemodynamic effects including stroke volume, stroke work, maximum pressure derivative, and systolic dyssynchrony (p=<0.001). Simultaneous His-bundle and left ventricular pacing improved stroke volume (88±31 mL vs 58±23 mL for AAI; P<0.001) and other hemodynamic indexes regardless of atrioventricular delay settings.
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