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(Circulation. 2000;101:869.)
© 2000 American Heart Association, Inc.
Clinical Investigation and Reports |
Permanent, Direct His-Bundle Pacing
A Novel Approach to Cardiac Pacing in Patients With Normal His-Purkinje Activation
From the Cardiology Division, Robert Packer Hospital, Sayre, Penn, and Medtronic, Inc, Minneapolis, Minn (D.A.C.).
Correspondence to Pramod Deshmukh, MD, Robert Packer Hospital, Arrhythmia Center, Guthrie Square, Sayre, PA 18840.
Background—Direct His-bundle pacing (DHBP) produces synchronous ventricular depolarization and improved cardiac function relative to apical pacing. Although it has been performed transiently in the electrophysiology laboratory and persistently in open-chested canines, permanent DHBP in humans has not been achieved.
Methods and Results—A total of 18 patients aged 69±10 years who
had a history of chronic atrial fibrillation, dilated
cardiomyopathy, and normal activation (ie, QRS
120
ms) were screened for permanent DHBP using an electrophysiology
catheter. In 14 patients, the His bundle could be reliably stimulated.
Of these 14, permanent DHBP using a fixed screw-in lead was successful
in 12 patients. Radiofrequency atrioventricular node
ablation was performed in patients exhibiting a fast
ventricular response. All patients received single-chamber
rate-responsive pacemakers. Acute pacing thresholds were 2.4±1.0 V at
a pulse duration of 0.5 ms. Lead complications included exit block
requiring reoperative adjustment and gross lead dislodgment.
Echocardiographic improvement in heart function was
shown by reductions in the left ventricular
end-diastolic dimension from 59±8 to 52±6 mm
(P0.01) and in the end-systolic dimension from
51±10 to 43±8 mm (P<0.01), with an accompanying
increase in fractional shortening from 14±7% to 20±10%
(P=0.05). The left ventricular ejection
fraction improved from 20±9% to 31±11% (P<0.01),
and the cardiothoracic ratio decreased from 0.61±0.06 to
0.57±0.07 (P<0.01). Despite DHBP, 2 patients
died at 8 and 36 months.
Conclusions—Permanent DHBP is feasible in select patients who have chronic atrial fibrillation and dilated cardiomyopathy. Long-term, DHBP results in a reduction of left ventricular dimensions and improved cardiac function.
Key Words: bundle of His • pacing • cardiomyopathy
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