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Heart failure (HF) patients (pts) with left bundle branch block (LBBB) are indicated for cardiac resynchronization therapy (CRT) that paces left and right ventricles almost at the same time. This study explored the feasibility of correction of LBBB by His bundle pacing (HBP) in HF pts.
A total of 57 pts who had HF and LBBB were enrolled. Acute HBP was attempted with a Select Site sheath (C304 and C315) and the Select Secure 3830 pacing lead that was placed in the atrioventricular septum. His bundle potential was recorded along with 12-lead ECG to confirm HBP. The initial acute HBP showed capture of His bundle with the presence of LBBB. The pacing output was then increased to capture His bundle with disappearance of LBBB (HBP-LBBBc). Pts in whom HBP parameters were acceptable received permanent HBP-LBBBc with follow-up visits for device performance at 1 week, 1, 3, 6, and 12 months.
Of 57 pts, 55 pts (96.5%) had successful acute HBP-LBBBc. Of these 55 pts, 45 pts received permanent HBP-LBBBc. 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 over the time was seen during 12 month follow-up. The intrinsic ECG QRS duration was 171.9±19.6 msec without HBP, 164.5±24.1 msec during HBP, and 107.9±20.8 msec during HBP-LBBBc (P <0.05 among them). Clinical outcomes were significantly improved during 12 month follow-up in pts who received permanent HBP-LBBBc.
HBP can correct LBBB in HF patients, which will be an alternative way to provide synchronized ventricular contraction via His-Purkinje system.