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His bundle pacing (HBP) utilizes the His-bundle to achieve synchronous ventricular activation. The study objective was to assess the feasibility of correction of LBBB by HBP and evaluated clinical outcomes of HBP in patients (pts) with heart failure (HF) and LBBB.
57 pts who had LBBB were enrolled. The Select Secure™ lead was placed in atrioventricular region for HBP. Regular follow-up visits were conducted for 12 months, including echocardiographic LVEDd and LVEF, NYHA classification and parameters.
All pts underwent acute HBP attempts and 55 pts (96.5%) showed the correction of LBBB by HBP. HBP was applied in 45 pts (78.9%) in whom HBP threshold were acceptable. The HBP-LBBBc threshold was significantly higher than HBP threshold without LBBB correction. The changes in HBP-LBBBc threshold were not statistically significant though a slight increase during follow-up.
HBP in 45 pts with a mean follow-up interval of 19.5±11.6 months, LVEDd decreased to 55.3±9.4 mm from the baseline 64.9±9.6 mm (P <0.001) while LVEF increased to 53.9±14.2% from 33.8±13.2% (P <0.001). NYHA classification reduced to 1.4±0.6 from the baseline 2.9±0.7 (P <0.001). Only 3 pts (6.7%) were hospitalized for HF treatment during the follow-up period after permanent HBP. The number of pts who used diuretics for HF management decreased from 40 (88.9%) at baseline to 24 (53.3%) (P <0.001).
Improved clinical and echocardiographic outcomes were observed after permanent HBP in heart failure patients who also presented ECG LBBB, which raises the possibility of HBP as an alternative to conventional CRT.