Key result
His bundle pacing significantly improved left ventricular ejection fraction from 35.3% to 43.1% (p < 0.0001) and reduced indexed left ventricular end-systolic volume at 6 months.
Why the study?
His bundle pacing maintains physiological ventricular activation and can normalize wide QRS duration in intraventricular conduction delay, but its usefulness in patients with impaired left ventricular systolic function needed evaluation.
Does His bundle pacing improve LVEF and reverse left ventricle remodeling in patients with impaired left ventricular systolic function (LVEF < 50%) requiring permanent pacing?
Observational (n=181)
No
Does His bundle pacing improve LVEF and reverse left ventricle remodeling in patients with impaired left ventricular systolic function (LVEF < 50%) requiring permanent pacing?
Absolute Event Rate: 43.1% vs 35.3%
p-value: p=<0.0001
His bundle pacing is feasible and associated with significant improvements in LVEF, reverse left ventricular remodeling, and NYHA functional class in patients with LVEF < 50% requiring permanent pacing.
His bundle pacing was associated with LVEF gains in this cohort; leaves open superiority versus right ventricular pacing in randomized trials.
BACKGROUND: His bundle pacing (HBP) maintains a physiological activation pattern of ventricular activation, and in patients with intraventricular conduction delay (IVCD) it can normalize wide QRS duration. METHODS: A total of 181 patients from the HBP registry were enrolled into a the study, which was conducted at the Department of Electrocardiology in Katowice, Poland. The patients had left ventricular ejection fraction (LVEF) < 50% and were implanted between November 2015 and April 2019. The HBP indications were as follows: 1) bradycardia and atrioventricular conduction disturbances with expected high pacing burden, 2) IVCD, LVEF ≤ 35%, with an indication for resynchronization therapy, 3) the need to upgrade to resynchronization therapy due to pacing-induced cardiomyopathy. Pacing parameters and echocardiographic and clinical data were assessed for up to 2 years of follow-up (FU). RESULTS: His bundle pacing was successful in 154 (85.1%) patients. Eighty-two patients completed a 6-month FU. The mean age was 70.6 ± 9.23 years, and 79% were males. At 6 months FU LVEF improved from 35.3 ± 8.22% to 43.1 ± 10.14% (p < 0.0001), and indexed left ventricular end-systolic volume (LVESVi) decreased from 63.1 ± 25.21 mL/m² to 51.9 ± 22.79 mL/m² (p < 0.0001). In 53.1%, the LVESVi reduction was greater than 15%. The improvement in LVEF and LVESVi was also observed after 24 months of FU. CONCLUSIONS: His bundle pacing in permanently paced patients when LVEF is reduced below 50% is associated with improvement in LVEF and reverse left ventricle remodeling.
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Gardas et al. (2022) conducted an observational in Impaired left ventricular systolic function (n=181). His bundle pacing vs. Baseline (pre-intervention) was evaluated on Left ventricular ejection fraction (LVEF) at 6 months (p=<0.0001). His bundle pacing significantly improved left ventricular ejection fraction from 35.3% to 43.1% (p < 0.0001) and reduced indexed left ventricular end-systolic volume at 6 months.
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