Permanent His-bundle pacing as an alternative to biventricular pacing for cardiac resynchronization therapy: A multicenter experience

Background Cardiac resynchronization therapy (CRT) using biventricular pacing (BVP) is effective in patients with heart failure, bundle branch block (BBB), or right ventricular pacing. Permanent His-bundle pacing (HBP) has been reported as an alternative option for CRT. Objective The purpose of this study was to assess the feasibility and outcomes of HBP in CRT eligible or failed patients. Methods HBP was attempted as a rescue strategy in patients with failed left ventricular lead or nonresponse to BVP (group I), or as a primary strategy in patients with AV block, BBB, or high ventricular pacing burden as an alternative to BVP (group II) in patients with indications for CRT. Implant characteristics, New York Heart Association functional class, and echocardiographic data were assessed in follow-up. Results HBP was successful in 95 of 106 patients (90%): 30 in group I and 65 in group II. Mean age was 71 ± 12 years and 30% were female, with BBB in 45%, paced rhythm in 39%, and AV block in 16%. His capture and BBB correction thresholds were 1.4 ± 0.9 V and 2.0 ± 1.2 V at 1 ms, respectively. During mean follow-up of 14 months, both groups demonstrated significant narrowing of QRS from 157 ± 33 ms to 117 ± 18 ms (P = .0001), increase in left ventricular ejection fraction from 30% ± 10% to 43% ± 13% (P = .0001), and improvement in New York Heart Association functional class from 2.8 ± 0.5 to 1.8 ± 0.6 (P = .0001) with HBP. Lead-related complications occurred in 7 patients. Conclusion Permanent HBP is a promising alternative for CRT. HBP may be considered as a rescue strategy for failed BVP and may be a reasonable primary alternative to BVP for CRT. Cardiac resynchronization therapy (CRT) using biventricular pacing (BVP) is effective in patients with heart failure, bundle branch block (BBB), or right ventricular pacing. Permanent His-bundle pacing (HBP) has been reported as an alternative option for CRT. The purpose of this study was to assess the feasibility and outcomes of HBP in CRT eligible or failed patients. HBP was attempted as a rescue strategy in patients with failed left ventricular lead or nonresponse to BVP (group I), or as a primary strategy in patients with AV block, BBB, or high ventricular pacing burden as an alternative to BVP (group II) in patients with indications for CRT. Implant characteristics, New York Heart Association functional class, and echocardiographic data were assessed in follow-up. HBP was successful in 95 of 106 patients (90%): 30 in group I and 65 in group II. Mean age was 71 ± 12 years and 30% were female, with BBB in 45%, paced rhythm in 39%, and AV block in 16%. His capture and BBB correction thresholds were 1.4 ± 0.9 V and 2.0 ± 1.2 V at 1 ms, respectively. During mean follow-up of 14 months, both groups demonstrated significant narrowing of QRS from 157 ± 33 ms to 117 ± 18 ms (P = .0001), increase in left ventricular ejection fraction from 30% ± 10% to 43% ± 13% (P = .0001), and improvement in New York Heart Association functional class from 2.8 ± 0.5 to 1.8 ± 0.6 (P = .0001) with HBP. Lead-related complications occurred in 7 patients. Permanent HBP is a promising alternative for CRT. HBP may be considered as a rescue strategy for failed BVP and may be a reasonable primary alternative to BVP for CRT.