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His bundle pacing (HBP) utilizes the intact His-Purkinje system to achieve synchronous ventricular activation. The study objective was to assess the feasibility of correction of left bundle branch block (LBBB) by HBP and evaluated clinical outcomes of permanent HBP in patients (pts) with heart failure (HF) and LBBB.
Fifty-seven HF pts who also had LBBB were enrolled after written consent forms were signed for HBP. Of 57 pts, 4 pts were CRT non-responders, 6 pts showed coronary sinus un-access, while the remaining patients were indicated for CRT. The Select Secure™ lead was placed in atrioventricular region for HBP. Regular follow-up visits were conducted. Echocardiographic left ventricular end-diastolic dimension (LVEDd) and left ventricular ejection fraction (LVEF), NYHA classification, hospitalizations, and use of diuretics for HF were determined at baseline and during follow-up visits after permanent HBP.
All pts underwent acute HBP attempts and 55 pts (96.5%) showed the correction of LBBB by HBP with disappearance of ECG LBBB. Permanent HBP was applied in 45 pts (78.9%) in whom HBP threshold were acceptable while the other 10 pts did not receive HBP due to high pacing threshold. After permanent HBP in 45 pts with a mean follow-up interval of 19.5±11.6 months (median 21.9 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 the baseline 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). All pts (100.0%) experienced at least one HF-related hospitalization prior to permanent HBP, while only 3 pts (6.7%) were hospitalized for heart failure treatment during the follow-up period after permanent HBP (P <0.001). The concentration of B-type natiuretic peptide decreased from 499.2±665.2 pg/ml to 247.9±558.2 pg/ml (< <0.001). The number of pts who used diuretics for HF management decreased from 40 (88.9%) at baseline to 24 (53.3%) after permanent HBP (P <0.001 for the reduction).
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.