AV optimized His bundle pacing did not increase peak oxygen uptake (+0.25 ml/kg/min; 95% CI -0.23 to +0.73; p=0.3) compared to no-pacing, but significantly improved quality of life.
RCT (n=167)
Double-blind
cross-over
Does AV optimized His bundle pacing improve peak oxygen uptake in patients with heart failure, LVEF ≤40%, and prolonged PR interval?
In patients with HFrEF and prolonged PR interval, AV optimized His bundle pacing did not improve peak oxygen uptake but significantly improved quality of life and was preferred by patients.
Effect estimate: Difference +0.25 ml/kg/min (95% CI -0.23 to +0.73)
p-value: p=0.3
AIMS: Excessive prolongation of PR interval impairs coupling of atrio-ventricular (AV) contraction, which reduces left ventricular pre-load and stroke volume, and worsens symptoms. His bundle pacing allows AV delay shortening while maintaining normal ventricular activation. HOPE-HF evaluated whether AV optimized His pacing is preferable to no-pacing, in a double-blind cross-over fashion, in patients with heart failure, left ventricular ejection fraction (LVEF) ≤40%, PR interval ≥200 ms and either QRS ≤140 ms or right bundle branch block. METHODS AND RESULTS: Patients had atrial and His bundle leads implanted (and an implantable cardioverter-defibrillator lead if clinically indicated) and were randomized to 6 months of pacing and 6 months of no-pacing utilizing a cross-over design. The primary outcome was peak oxygen uptake during symptom-limited exercise. Quality of life, LVEF and patients' holistic symptomatic preference between arms were secondary outcomes. Overall, 167 patients were randomized: 90% men, 69 ± 10 years, QRS duration 124 ± 26 ms, PR interval 249 ± 59 ms, LVEF 33 ± 9%. Neither peak oxygen uptake (+0.25 ml/kg/min, 95% confidence interval CI -0.23 to +0.73, p = 0.3) nor LVEF (+0.5%, 95% CI -0.7 to 1.6, p = 0.4) changed with pacing but Minnesota Living with Heart Failure quality of life improved significantly (-3.7, 95% CI -7.1 to -0.3, p = 0.03). Seventy-six percent of patients preferred His bundle pacing-on and 24% pacing-off (p < 0.0001). CONCLUSION: His bundle pacing did not increase peak oxygen uptake but, under double-blind conditions, significantly improved quality of life and was symptomatically preferred by the clear majority of patients. Ventricular pacing delivered via the His bundle did not adversely impact ventricular function during the 6 months.
Whinnett et al. (2022) conducted an RCT in heart failure (n=167). AV optimized His bundle pacing vs. no-pacing was evaluated on peak oxygen uptake during symptom-limited exercise (Difference +0.25 ml/kg/min, 95% CI -0.23 to +0.73, p=0.3). AV optimized His bundle pacing did not increase peak oxygen uptake (+0.25 ml/kg/min; 95% CI -0.23 to +0.73; p=0.3) compared to no-pacing, but significantly improved quality of life.