Abstract 20082: Feasibility of His Bundle Pacing in Patients Meeting Criteria for Cardiac Resynchronization Therapy and Implantable Cardioverter-defibrillator
Objective: The role of His bundle pacing to physiologically narrow QRS duration in patients meeting criteria for CRT/CRT-D is not well understood.
Methods: Patients with CRT/CRT-D indication with failed CS lead placement, suboptimal coronary venous targets, or those who opted for His bundle pacing underwent implantation of a His bundle lead, along with an RV defibrillator lead if indicated. In all patients, the His bundle pacing lead was placed into the LV lead port with CRT pulse generator. The LV-RV offset was programmed at maximum, with RV lead subthreshold to minimize fusion. An atrial lead was implanted if the patient was not in permanent atrial fibrillation.
Results: Thirteen patients (65±18 years, 7 males, mean LVEF 27.3±8.9%, QRS duration 180±30ms, and 11 with LBBB) underwent His bundle pacing. The mean PR interval in this cohort was 220±111ms, 3 patients had complete heart block, 3 had permanent atrial fibrillation, and 9 required ICD placement. The His pacing lead (Medtronic 3830 Select Secure) was successfully placed in 12 of 13 patients, with narrowing of the QRS duration to 120±23ms (p<0.0001). No complications or lead dislodgements were seen. At 6-month follow up, LVEF increased by an average of 18.7%, and left ventricular internal dimension in diastole(LVIDd) decreased by 0.9cm. Echocardiographic global longitudinal strain improved from -9.1 to -10.5%.
Conclusions: In patients meeting criteria for CRT/CRT-D implantation, QRS narrowing achieved by His bundle pacing is feasible, and is associated with favorable mechanical and clinical outcomes.
Author Disclosures: O.A. Ajijola: None. C. Macias: None. V. Garg: None. G. Vorobiof: None. A.H. Mally: None. K. Shivkumar: None. R. Tung: None.
- © 2015 by American Heart Association, Inc.