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Cardiac resynchronization therapy in non-ischemic cardiomyopathy: a comparative non-randomized study of His Bundle pacing versus biventricular pacing

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Abstract

Background

Cardiac resynchronization therapy (CRT) via permanent His bundle pacing (pHBP) has gained acceptance globally, but robust studies comparing pHBP-CRT with classic CRT are lacking. In this study, we aimed to compare the improvement in left ventricular ejection fraction (LVEF) after pHBP-CRT versus classic CRT.

Methods

This was a single-center study comparing a prospective series of pHBP-CRT with a historical series of CRT via classic biventricular pacing (BVP). Patients with non-ischemic cardiomyopathy, baseline LVEF < 35%, left bundle branch block (LBBB), and CRT indications were selected.

Results

Fifty-one patients underwent classic CRT and 52 patients underwent pHBP-CRT. In the classic CRT group, the median (interquartile range) basal LVEF was 30% (IQR, 29–35%) before implantation and 40% (35–48%) at follow-up. In the pHBP-CRT group, the median basal LVEF was 30% (28–34%) before implantation and 55% (45–60%) at follow-up, with significant differences between both modalities at follow-up (p = 0.001). The median long term His recruitment threshold with LBBB correction was 1.25 (1–2.5) V at 0.4 ms in cases of pHBP-CRT, compared to a left ventricular coronary sinus threshold of 1.25 (1–1.75) V in cases of classic CRT (p = 0.48). After CRT, the median paced QRS was 135 (120–145) ms for pHBP-CRT versus 140 (130–150) ms for BVP-CRT (p = 0.586).

Conclusions

The improvement in LVEF was superior with pHBP-CRT than with classic CRT. The thresholds at follow-up were similar in both groups.

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Abbreviations

BBB:

Bundle branch block

BVP:

Biventricular pacing

CRT:

Cardiac resynchronization therapy

HBP:

His bundle pacing

HF:

Heart failure

ICD:

Implantable cardioverter-defibrillator

LBBB:

Left bundle branch block

LV:

Left ventricle

LVEF:

Left ventricular ejection fraction

pHBP:

Permanent His bundle pacing

VP:

Ventricular pacing

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Funding

This study received a grant from the Andalusian Society of Cardiology.

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Authors and Affiliations

  1. Arrhythmia Unit, Department of Cardiology, Hospital Juan Ramon Jimenez (HJRJ)), Ronda Exterior Norte s/n. 21005, Huelva, Spain

    Pablo Moriña-Vázquez, María Teresa Moraleda-Salas, Álvaro Arce-León, José Venegas-Gamero, Juan Manuel Fernández-Gómez, Irene Esteve-Ruiz & Rafael Barba-Pichardo

  2. Department of Cardiology, HJRJ, Huelva, Spain

    Adrián Rodríguez-Albarrán

Authors
  1. Pablo Moriña-Vázquez
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  2. María Teresa Moraleda-Salas
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  3. Adrián Rodríguez-Albarrán
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  4. Álvaro Arce-León
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  5. José Venegas-Gamero
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  6. Juan Manuel Fernández-Gómez
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  7. Irene Esteve-Ruiz
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  8. Rafael Barba-Pichardo
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Corresponding author

Correspondence to María Teresa Moraleda-Salas.

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The authors declare no competing interests.

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Clinical perspective

What is known

• There is a lack of conclusive studies comparing cardiac resynchronization therapy via permanent His bundle pacing with classic cardiac resynchronization therapy.

What the study adds

• The improvement in left ventricular ejection fraction was superior permanent His bundle pacing than with the classic method.

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Moriña-Vázquez, P., Moraleda-Salas, M.T., Rodríguez-Albarrán, A. et al. Cardiac resynchronization therapy in non-ischemic cardiomyopathy: a comparative non-randomized study of His Bundle pacing versus biventricular pacing. J Interv Card Electrophysiol 66, 1077–1084 (2023). https://doi.org/10.1007/s10840-022-01192-2

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  • DOI: https://doi.org/10.1007/s10840-022-01192-2

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