Atrioventricular Optimized Direct His Bundle Pacing Improves Acute Hemodynamic Function in Patients With Heart Failure and PR Interval Prolongation Without Left Bundle Branch Block.

JACC. Clinical Electrophysiology
S M Afzal SohaibZachary I Whinnett

Abstract

The purpose of this study was to investigate whether heart failure patients with narrow QRS duration (or right bundle branch block) but with long PR interval gain acute hemodynamic benefit from atrioventricular (AV) optimization. We tested this with biventricular pacing and (to deliver pure AV shortening) direct His bundle pacing. Benefits of pacing for heart failure have previously been indicated by acute hemodynamic studies and verified in outcome studies. A new target for pacing in heart failure may be PR interval prolongation, which is associated with 58% higher mortality regardless of QRS duration. We enrolled 16 consecutive patients with systolic heart failure, PR interval prolongation (mean, 254 ± 62 ms) and narrow QRS duration (n = 13; mean QRS duration: 119 ± 17 ms) or right bundle branch block (n = 3; mean, QRS duration: 156 ± 18 ms). We successfully delivered temporary direct His bundle pacing in 14 patients and temporary biventricular pacing in 14 participants. We performed AV optimization using invasive systolic blood pressure obtaining parabolic responses (mean R2: 0.90 for His, and 0.85 for biventricular pacing). The mean increment in systolic BP compared with intrinsic ventricular conduction was 4.1 mm Hg (95% c...Continue Reading

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Citations

Dec 6, 2018·Pacing and Clinical Electrophysiology : PACE·Zhiyong QianXiaofeng Hou
Feb 9, 2019·European Journal of Heart Failure·Sung Woo ChoSeung-Jung Park
Mar 12, 2019·Journal of the American Heart Association·Andrew J M LewisBadrinathan Chandrasekaran
May 10, 2020·Herzschrittmachertherapie & Elektrophysiologie·Carsten W IsraelSergio Richter
Aug 29, 2020·Current Heart Failure Reports·Nadine AliZachary Whinnett
Jul 4, 2018·Arrhythmia & Electrophysiology Review·Nadine AliS M Afzal Sohaib
Mar 2, 2019·Current Heart Failure Reports·Philip L MarGopi Dandamudi

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