His Resynchronization Versus Biventricular Pacing in Patients With Heart Failure and Left Bundle Branch Block
His bundle pacing is a new method for delivering cardiac resynchronization therapy (CRT). The authors performed a head-to-head, high-precision, acute crossover comparison between His bundle pacing and conventional biventricular CRT, measuring effects on ventricular activation and acute hemodynamic f...
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| Published in | Journal of the American College of Cardiology Vol. 72; no. 24; pp. 3112 - 3122 |
|---|---|
| Main Authors | , , , , , , , , , , , , , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
United States
Elsevier Inc
18.12.2018
Elsevier Limited Elsevier Biomedical |
| Subjects | |
| Online Access | Get full text |
| ISSN | 0735-1097 1558-3597 1558-3597 |
| DOI | 10.1016/j.jacc.2018.09.073 |
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| Abstract | His bundle pacing is a new method for delivering cardiac resynchronization therapy (CRT).
The authors performed a head-to-head, high-precision, acute crossover comparison between His bundle pacing and conventional biventricular CRT, measuring effects on ventricular activation and acute hemodynamic function.
Patients with heart failure and left bundle branch block referred for conventional biventricular CRT were recruited. Using noninvasive epicardial electrocardiographic imaging, the authors identified patients in whom His bundle pacing shortened left ventricular activation time. In these patients, the authors compared the hemodynamic effects of His bundle pacing against biventricular pacing using a high-multiple repeated alternation protocol to minimize the effect of noise, as well as comparing effects on ventricular activation.
In 18 of 23 patients, left ventricular activation time was significantly shortened by His bundle pacing. Seventeen patients had a complete electromechanical dataset. In them, His bundle pacing was more effective at delivering ventricular resynchronization than biventricular pacing: greater reduction in QRS duration (−18.6 ms; 95% confidence interval [CI]: −31.6 to −5.7 ms; p = 0.007), left ventricular activation time (−26 ms; 95% CI: −41 to −21 ms; p = 0.002), and left ventricular dyssynchrony index (−11.2 ms; 95% CI: −16.8 to −5.6 ms; p < 0.001). His bundle pacing also produced a greater acute hemodynamic response (4.6 mm Hg; 95% CI: 0.2 to 9.1 mm Hg; p = 0.04). The incremental activation time reduction with His bundle pacing over biventricular pacing correlated with the incremental hemodynamic improvement with His bundle pacing over biventricular pacing (R = 0.70; p = 0.04).
His resynchronization delivers better ventricular resynchronization, and greater improvement in hemodynamic parameters, than biventricular pacing.
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| AbstractList | AbstractBackgroundHis bundle pacing is a new method for delivering cardiac resynchronization therapy (CRT). ObjectivesThe authors performed a head-to-head, high-precision, acute crossover comparison between His bundle pacing and conventional biventricular CRT, measuring effects on ventricular activation and acute hemodynamic function. MethodsPatients with heart failure and left bundle branch block referred for conventional biventricular CRT were recruited. Using noninvasive epicardial electrocardiographic imaging, the authors identified patients in whom His bundle pacing shortened left ventricular activation time. In these patients, the authors compared the hemodynamic effects of His bundle pacing against biventricular pacing using a high-multiple repeated alternation protocol to minimize the effect of noise, as well as comparing effects on ventricular activation. ResultsIn 18 of 23 patients, left ventricular activation time was significantly shortened by His bundle pacing. Seventeen patients had a complete electromechanical dataset. In them, His bundle pacing was more effective at delivering ventricular resynchronization than biventricular pacing: greater reduction in QRS duration (−18.6 ms; 95% confidence interval [CI]: −31.6 to −5.7 ms; p = 0.007), left ventricular activation time (−26 ms; 95% CI: −41 to −21 ms; p = 0.002), and left ventricular dyssynchrony index (−11.2 ms; 95% CI: −16.8 to −5.6 ms; p < 0.001). His bundle pacing also produced a greater acute hemodynamic response (4.6 mm Hg; 95% CI: 0.2 to 9.1 mm Hg; p = 0.04). The incremental activation time reduction with His bundle pacing over biventricular pacing correlated with the incremental hemodynamic improvement with His bundle pacing over biventricular pacing (R = 0.70; p = 0.04). ConclusionsHis resynchronization delivers better ventricular resynchronization, and greater improvement in hemodynamic parameters, than biventricular pacing. His bundle pacing is a new method for delivering cardiac resynchronization therapy (CRT).BACKGROUNDHis bundle pacing is a new method for delivering cardiac resynchronization therapy (CRT).The authors performed a head-to-head, high-precision, acute crossover comparison between His bundle pacing and conventional biventricular CRT, measuring effects on ventricular activation and acute hemodynamic function.OBJECTIVESThe authors performed a head-to-head, high-precision, acute crossover comparison between His bundle pacing and conventional biventricular CRT, measuring effects on ventricular activation and acute hemodynamic function.Patients with heart failure and left bundle branch block referred for conventional biventricular CRT were recruited. Using noninvasive epicardial electrocardiographic imaging, the authors identified patients in whom His bundle pacing shortened left ventricular activation time. In these patients, the authors compared the hemodynamic effects of His bundle pacing against biventricular pacing using a high-multiple repeated alternation protocol to minimize the effect of noise, as well as comparing effects on ventricular activation.METHODSPatients with heart failure and left bundle branch block referred for conventional biventricular CRT were recruited. Using noninvasive epicardial electrocardiographic imaging, the authors identified patients in whom His bundle pacing shortened left ventricular activation time. In these patients, the authors compared the hemodynamic effects of His bundle pacing against biventricular pacing using a high-multiple repeated alternation protocol to minimize the effect of noise, as well as comparing effects on ventricular activation.In 18 of 23 patients, left ventricular activation time was significantly shortened by His bundle pacing. Seventeen patients had a complete electromechanical dataset. In them, His bundle pacing was more effective at delivering ventricular resynchronization than biventricular pacing: greater reduction in QRS duration (-18.6 ms; 95% confidence interval [CI]: -31.6 to -5.7 ms; p = 0.007), left ventricular activation time (-26 ms; 95% CI: -41 to -21 ms; p = 0.002), and left ventricular dyssynchrony index (-11.2 ms; 95% CI: -16.8 to -5.6 ms; p < 0.001). His bundle pacing also produced a greater acute hemodynamic response (4.6 mm Hg; 95% CI: 0.2 to 9.1 mm Hg; p = 0.04). The incremental activation time reduction with His bundle pacing over biventricular pacing correlated with the incremental hemodynamic improvement with His bundle pacing over biventricular pacing (R = 0.70; p = 0.04).RESULTSIn 18 of 23 patients, left ventricular activation time was significantly shortened by His bundle pacing. Seventeen patients had a complete electromechanical dataset. In them, His bundle pacing was more effective at delivering ventricular resynchronization than biventricular pacing: greater reduction in QRS duration (-18.6 ms; 95% confidence interval [CI]: -31.6 to -5.7 ms; p = 0.007), left ventricular activation time (-26 ms; 95% CI: -41 to -21 ms; p = 0.002), and left ventricular dyssynchrony index (-11.2 ms; 95% CI: -16.8 to -5.6 ms; p < 0.001). His bundle pacing also produced a greater acute hemodynamic response (4.6 mm Hg; 95% CI: 0.2 to 9.1 mm Hg; p = 0.04). The incremental activation time reduction with His bundle pacing over biventricular pacing correlated with the incremental hemodynamic improvement with His bundle pacing over biventricular pacing (R = 0.70; p = 0.04).His resynchronization delivers better ventricular resynchronization, and greater improvement in hemodynamic parameters, than biventricular pacing.CONCLUSIONSHis resynchronization delivers better ventricular resynchronization, and greater improvement in hemodynamic parameters, than biventricular pacing. His bundle pacing is a new method for delivering cardiac resynchronization therapy (CRT). The authors performed a head-to-head, high-precision, acute crossover comparison between His bundle pacing and conventional biventricular CRT, measuring effects on ventricular activation and acute hemodynamic function. Patients with heart failure and left bundle branch block referred for conventional biventricular CRT were recruited. Using noninvasive epicardial electrocardiographic imaging, the authors identified patients in whom His bundle pacing shortened left ventricular activation time. In these patients, the authors compared the hemodynamic effects of His bundle pacing against biventricular pacing using a high-multiple repeated alternation protocol to minimize the effect of noise, as well as comparing effects on ventricular activation. In 18 of 23 patients, left ventricular activation time was significantly shortened by His bundle pacing. Seventeen patients had a complete electromechanical dataset. In them, His bundle pacing was more effective at delivering ventricular resynchronization than biventricular pacing: greater reduction in QRS duration (−18.6 ms; 95% confidence interval [CI]: −31.6 to −5.7 ms; p = 0.007), left ventricular activation time (−26 ms; 95% CI: −41 to −21 ms; p = 0.002), and left ventricular dyssynchrony index (−11.2 ms; 95% CI: −16.8 to −5.6 ms; p < 0.001). His bundle pacing also produced a greater acute hemodynamic response (4.6 mm Hg; 95% CI: 0.2 to 9.1 mm Hg; p = 0.04). The incremental activation time reduction with His bundle pacing over biventricular pacing correlated with the incremental hemodynamic improvement with His bundle pacing over biventricular pacing (R = 0.70; p = 0.04). His resynchronization delivers better ventricular resynchronization, and greater improvement in hemodynamic parameters, than biventricular pacing. [Display omitted] His bundle pacing is a new method for delivering cardiac resynchronization therapy (CRT). The authors performed a head-to-head, high-precision, acute crossover comparison between His bundle pacing and conventional biventricular CRT, measuring effects on ventricular activation and acute hemodynamic function. Patients with heart failure and left bundle branch block referred for conventional biventricular CRT were recruited. Using noninvasive epicardial electrocardiographic imaging, the authors identified patients in whom His bundle pacing shortened left ventricular activation time. In these patients, the authors compared the hemodynamic effects of His bundle pacing against biventricular pacing using a high-multiple repeated alternation protocol to minimize the effect of noise, as well as comparing effects on ventricular activation. In 18 of 23 patients, left ventricular activation time was significantly shortened by His bundle pacing. Seventeen patients had a complete electromechanical dataset. In them, His bundle pacing was more effective at delivering ventricular resynchronization than biventricular pacing: greater reduction in QRS duration (-18.6 ms; 95% confidence interval [CI]: -31.6 to -5.7 ms; p = 0.007), left ventricular activation time (-26 ms; 95% CI: -41 to -21 ms; p = 0.002), and left ventricular dyssynchrony index (-11.2 ms; 95% CI: -16.8 to -5.6 ms; p < 0.001). His bundle pacing also produced a greater acute hemodynamic response (4.6 mm Hg; 95% CI: 0.2 to 9.1 mm Hg; p = 0.04). The incremental activation time reduction with His bundle pacing over biventricular pacing correlated with the incremental hemodynamic improvement with His bundle pacing over biventricular pacing (R = 0.70; p = 0.04). His resynchronization delivers better ventricular resynchronization, and greater improvement in hemodynamic parameters, than biventricular pacing. BackgroundHis bundle pacing is a new method for delivering cardiac resynchronization therapy (CRT).ObjectivesThe authors performed a head-to-head, high-precision, acute crossover comparison between His bundle pacing and conventional biventricular CRT, measuring effects on ventricular activation and acute hemodynamic function.MethodsPatients with heart failure and left bundle branch block referred for conventional biventricular CRT were recruited. Using noninvasive epicardial electrocardiographic imaging, the authors identified patients in whom His bundle pacing shortened left ventricular activation time. In these patients, the authors compared the hemodynamic effects of His bundle pacing against biventricular pacing using a high-multiple repeated alternation protocol to minimize the effect of noise, as well as comparing effects on ventricular activation.ResultsIn 18 of 23 patients, left ventricular activation time was significantly shortened by His bundle pacing. Seventeen patients had a complete electromechanical dataset. In them, His bundle pacing was more effective at delivering ventricular resynchronization than biventricular pacing: greater reduction in QRS duration (−18.6 ms; 95% confidence interval [CI]: −31.6 to −5.7 ms; p = 0.007), left ventricular activation time (−26 ms; 95% CI: −41 to −21 ms; p = 0.002), and left ventricular dyssynchrony index (−11.2 ms; 95% CI: −16.8 to −5.6 ms; p < 0.001). His bundle pacing also produced a greater acute hemodynamic response (4.6 mm Hg; 95% CI: 0.2 to 9.1 mm Hg; p = 0.04). The incremental activation time reduction with His bundle pacing over biventricular pacing correlated with the incremental hemodynamic improvement with His bundle pacing over biventricular pacing (R = 0.70; p = 0.04).ConclusionsHis resynchronization delivers better ventricular resynchronization, and greater improvement in hemodynamic parameters, than biventricular pacing. |
| Author | Wright, Ian J. Qureshi, Norman A. Francis, Darrel P. Keene, Daniel Arnold, Ahran D. Lim, Phang Boon Koa-Wing, Michael Linton, Nick W.F. Whinnett, Zachary I. Ellenbogen, Kenneth A. Howard, James P. Kanagaratnam, Prapa Sohaib, S.M. Afzal Tanner, Mark Lefroy, David C. Davies, D. Wyn Shun-Shin, Matthew J. Cole, Graham D. Muthumala, Amal Peters, Nicholas S. |
| AuthorAffiliation | d Virginia Commonwealth University, Richmond, Virginia c North Middlesex Hospital NHS Trust, London, United Kingdom a National Heart and Lung Institute, Imperial College London, London, United Kingdom b St. Bartholomew’s Hospital, London, United Kingdom |
| AuthorAffiliation_xml | – name: a National Heart and Lung Institute, Imperial College London, London, United Kingdom – name: c North Middlesex Hospital NHS Trust, London, United Kingdom – name: d Virginia Commonwealth University, Richmond, Virginia – name: b St. Bartholomew’s Hospital, London, United Kingdom |
| Author_xml | – sequence: 1 givenname: Ahran D. surname: Arnold fullname: Arnold, Ahran D. organization: National Heart and Lung Institute, Imperial College London, London, United Kingdom – sequence: 2 givenname: Matthew J. surname: Shun-Shin fullname: Shun-Shin, Matthew J. organization: National Heart and Lung Institute, Imperial College London, London, United Kingdom – sequence: 3 givenname: Daniel surname: Keene fullname: Keene, Daniel organization: National Heart and Lung Institute, Imperial College London, London, United Kingdom – sequence: 4 givenname: James P. surname: Howard fullname: Howard, James P. organization: National Heart and Lung Institute, Imperial College London, London, United Kingdom – sequence: 5 givenname: S.M. Afzal surname: Sohaib fullname: Sohaib, S.M. Afzal organization: National Heart and Lung Institute, Imperial College London, London, United Kingdom – sequence: 6 givenname: Ian J. surname: Wright fullname: Wright, Ian J. organization: National Heart and Lung Institute, Imperial College London, London, United Kingdom – sequence: 7 givenname: Graham D. surname: Cole fullname: Cole, Graham D. organization: National Heart and Lung Institute, Imperial College London, London, United Kingdom – sequence: 8 givenname: Norman A. surname: Qureshi fullname: Qureshi, Norman A. organization: National Heart and Lung Institute, Imperial College London, London, United Kingdom – sequence: 9 givenname: David C. surname: Lefroy fullname: Lefroy, David C. organization: National Heart and Lung Institute, Imperial College London, London, United Kingdom – sequence: 10 givenname: Michael surname: Koa-Wing fullname: Koa-Wing, Michael organization: National Heart and Lung Institute, Imperial College London, London, United Kingdom – sequence: 11 givenname: Nick W.F. surname: Linton fullname: Linton, Nick W.F. organization: National Heart and Lung Institute, Imperial College London, London, United Kingdom – sequence: 12 givenname: Phang Boon surname: Lim fullname: Lim, Phang Boon organization: National Heart and Lung Institute, Imperial College London, London, United Kingdom – sequence: 13 givenname: Nicholas S. surname: Peters fullname: Peters, Nicholas S. organization: National Heart and Lung Institute, Imperial College London, London, United Kingdom – sequence: 14 givenname: D. Wyn surname: Davies fullname: Davies, D. Wyn organization: National Heart and Lung Institute, Imperial College London, London, United Kingdom – sequence: 15 givenname: Amal surname: Muthumala fullname: Muthumala, Amal organization: St. Bartholomew’s Hospital, London, United Kingdom – sequence: 16 givenname: Mark surname: Tanner fullname: Tanner, Mark organization: National Heart and Lung Institute, Imperial College London, London, United Kingdom – sequence: 17 givenname: Kenneth A. surname: Ellenbogen fullname: Ellenbogen, Kenneth A. organization: Virginia Commonwealth University, Richmond, Virginia – sequence: 18 givenname: Prapa surname: Kanagaratnam fullname: Kanagaratnam, Prapa organization: National Heart and Lung Institute, Imperial College London, London, United Kingdom – sequence: 19 givenname: Darrel P. surname: Francis fullname: Francis, Darrel P. email: Research@DrFrancis.org organization: National Heart and Lung Institute, Imperial College London, London, United Kingdom – sequence: 20 givenname: Zachary I. surname: Whinnett fullname: Whinnett, Zachary I. organization: National Heart and Lung Institute, Imperial College London, London, United Kingdom |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/30545450$$D View this record in MEDLINE/PubMed |
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| Keywords | ECGI noninvasive epicardial mapping CRT cardiac resynchronization therapy CI His resynchronization therapy ECG LV LVDI biventricular pacing His bundle pacing QRSd AV LBBB HBP LVAT-95 BVP LVAT left ventricle/ventricular electrocardiogram/electrocardiographic left ventricular activation time left ventricular dyssynchrony index left bundle branch block atrioventricular confidence interval QRS duration left ventricular activation time spanning 95% of activations electrocardiographic imaging |
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| Notes | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 14 ObjectType-Article-2 ObjectType-Feature-1 content type line 23 Drs. Arnold and Shun-Shin contributed equally to this work. |
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| Snippet | His bundle pacing is a new method for delivering cardiac resynchronization therapy (CRT).
The authors performed a head-to-head, high-precision, acute crossover... AbstractBackgroundHis bundle pacing is a new method for delivering cardiac resynchronization therapy (CRT). ObjectivesThe authors performed a head-to-head,... BackgroundHis bundle pacing is a new method for delivering cardiac resynchronization therapy (CRT).ObjectivesThe authors performed a head-to-head,... His bundle pacing is a new method for delivering cardiac resynchronization therapy (CRT).BACKGROUNDHis bundle pacing is a new method for delivering cardiac... |
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| SubjectTerms | Aged Aged, 80 and over biventricular pacing Blood pressure Bundle of His Bundle-Branch Block - complications Bundle-Branch Block - therapy Cardiac function cardiac resynchronization therapy Cardiac Resynchronization Therapy - methods Cardiac Resynchronization Therapy Devices Cardiology Cardiovascular ECGI Electrocardiography Female Heart diseases Heart failure Heart Failure - complications His bundle pacing His resynchronization therapy Humans Male Medical imaging Middle Aged Morphology noninvasive epicardial mapping Patients Prospective Studies Studies Treatment Outcome Ventricle |
| Title | His Resynchronization Versus Biventricular Pacing in Patients With Heart Failure and Left Bundle Branch Block |
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