Author + information
- Benjamin J. Scherlag, PhD∗ ( and )
- Khaled Elkholey, MD
- ↵∗Heart Rhythm Institute, University of Oklahoma Health Sciences Center, 800 Stanton L. Young Boulevard, Suite 5400, Oklahoma City, Oklahoma 73104
Abdelrahman et al. (1) reported the clinical results of a comparative study in patients receiving permanent His bundle pacing with those implanted with right ventricular pacemakers. They were able to achieve permanent His bundle pacing in 92% of the 304 patients in consecutive studies compared with 433 who had right ventricular pacing. During the follow-up period, mortality, heart failure hospitalizations, and upgrades to biventricular pacing were all significantly reduced in patients with His bundle pacing compared with those with right ventricular pacing. Although His bundle pacing in patients was reported as early as 1970 (2), it was not until 2000, when Deshmukh et al. (3) used a fixed, screw-in lead to achieve permanent His bundle pacing in 12 of 14 patients with chronic atrial fibrillation and dilated cardiomyopathy.
From a historical perspective, it should be noted that 50 years ago in an experimental study, Kosowsky et al. (4) used plunge wire inserted through the atrial wall to hook onto the His bundle. This allowed stable His bundle recordings as well as His bundle pacing. At any A-V interval, there was a significantly greater response with His bundle pacing on left ventricular pressure, rate of rise of left ventricular pressure, and aortic flow compared with right ventricular apex pacing.
The clinical findings of Abdelrahman et al. (1) provide further evidence that permanent His bundle pacing not only may supplant right ventricular pacing but also may be the future replacement for biventricular pacing for cardiac resynchronization across the spectrum of QRS durations in patients with heart failure.
Please note: This work is supported by an unrestricted grant from the Helen and Wilton Webster Foundation through the Oklahoma Research Foundation. The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- 2018 American College of Cardiology Foundation
- Abdelrahman M.,
- Subzposh F.A.,
- Beer D.,
- et al.
- Narula O.S.,
- Scherlag B.J.,
- Samet P.
- Deshmukh P.,
- Casavant D.A.,
- Romanyshyn M.,
- Anderson K.