Key result
His bundle pacing maintains long-term effectiveness in ~86% of LBBB patients while normalizing QRS.
Why the study?
His bundle pacing can correct LBBB and ventricular dyssynchrony, but its technical and clinical outcomes in patients referred for PM implantation with preserved EF required analysis.
Does permanent His bundle pacing improve QRS duration and preserve ejection fraction in patients with LBBB requiring pacemaker implantation?
Observational (n=36)
Does permanent His bundle pacing improve QRS duration and preserve ejection fraction in patients with LBBB requiring pacemaker implantation?
Permanent His bundle pacing is technically feasible and maintains preserved ejection fraction over long-term follow-up in patients with LBBB requiring pacing.
Long-term selective HBP appears feasible with preserved EF in LBBB; leaves open superiority versus conventional pacing in randomized trials.
Background: His bundle pacing (HBP) can correct left bundle branch block (LBBB) allowing QRS normalization and correction of ventricular dyssynchrony. Objective: Aim of the present study was to analyze technical and clinical outcomes of HBP in LBBB patients referred for PM implantation with preserved ejection fraction (EF). Methods: 36 patients (75±8 years; 17 males) presenting LBBB (mean QRS duration 163±23 ms) received permanent HBP. Indications for pacing were AV block (25 pts; 70%), sinus node disease (8 pts; 22%), AF with slow ventricular rate (3 pts; 8%). A back up lead was implanted in RV apex in 15 (42%) patients. 5 (14%) pts had ischemic cardiomyopathy, 30 (83%) pts had hypertension, 6 (17%) pts had diabetes, and 2 (5%) pts had severe kidney disease. 4 (16%) pts had permanent AF. Basal mean EF was 53±11%. Mean NYHA class was 1,7±0,7. Results: In 32 patients (89%) we obtained selective HBP: in 19 patients (53%) HBP normalized QRS morphology and duration (LBBB disappeared) and in 13 patients (36%) QRS remained unchanged. In the remaining 4 patients (11%) we obtained non-selective HBP with slight QRS enlargement and local myocardial capture. HBP threshold at implant was 1.5±0.9 [email protected] ms. During a mean follow-up of 5.3±3.6 years, 31 (86%) patients showed persistence of effective HBP while 5 patients (14%) showed technical problems that in two cases required new lead implant. During follow-up 14 pacemakers reached EOL. VP>40% was recorded in 86% of pts (mean VP 84%). High AF burden (AT/AF>50%) was found in 33% pts. A back-up lead during follow-up was added in 1 patient. The mean EF at the end of follow-up was 56±11% (P=NS). The subgroup of patients with QRS normalization showed a slight improvement of EF from 50±11% to 54±12%. In the whole population only one patient experienced heart failure hospitalization.
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Zanon et al. (2018) conducted an observational in Left bundle branch block (LBBB) with preserved ejection fraction (n=36). His bundle pacing (HBP) was evaluated on Technical and clinical outcomes (including QRS normalization and ejection fraction changes). His bundle pacing in LBBB patients achieved selective HBP in 89% of cases, normalizing QRS in 53%, with persistence of effective pacing in 86% over a mean 5.3-year follow-up.
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