His-Bundle Pacing: A Novel Treatment for Left Bundle Branch Block mediated Cardiomyopathy

Rajeev Singh, Subodh Devabhaktuni, Fatima Ezzeddine, Joel Simon, Kavita Khaira, Gopi Dandamudi
Journal of Cardiovascular Electrophysiology 2020 July 26

BACKGROUND: Chronic left bundle branch block (LBBB) can lead to LBBB mediated cardiomyopathy from left ventricular dysynchrony. His-bundle pacing (HBP) results in direct electrical synchrony using the native His Purkinje system, providing a novel treatment for this cardiomyopathy.

OBJECTIVE: To assess the feasibility of HBP for cardiac resynchronization therapy (CRT) in LBBB mediated cardiomyopathy patients.

METHODS: Retrospective database review was conducted on patients who underwent cardiac resynchronization therapy by the HBP capable provider at Indiana University Health and Ezkenazi Hospital from August 2015 to August 2017. A subset of patients who met the pre-defined syndrome criteria of LBBB mediated cardiomyopathy who underwent HBP were identified. Clinical, echocardiographic, and electrocardiographic variables were extracted at baseline and follow-up.

RESULTS: Nine patients had cardiomyopathy and LBBB. Among those two were lost to follow up. Seven patients were included in the analysis. The average time from device implantation to last follow-up was 14.5 months. Left ventricular ejection fraction improved on average from 25% to 50% (p= 0.0001). Left ventricular end systolic dimension (LVESD) decreased from 47 mm to 37 mm (p = 0.003) and left ventricular end diastolic dimension (LVEDD) decreased from 55 mm to 48 mm (p= 0.03). QRS duration with HBP-CRT decreased from 152ms to 115ms. New York Heart Association (NYHA) classification improved from an average of 2.7 to 2.

CONCLUSION: His-bundle pacing is a viable technique for pursuing cardiac resynchronization therapy in patients with LBBB mediated cardiomyopathy. This article is protected by copyright. All rights reserved.

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