Advertisement

Current Heart Failure Reports

, Volume 16, Issue 1, pp 47–56 | Cite as

His Bundle Pacing in Heart Failure—Concept and Current Data

  • Philip L. Mar
  • Subodh R. Devabhaktuni
  • Gopi DandamudiEmail author
Devices (C Veltmann, Section Editor)
  • 63 Downloads
Part of the following topical collections:
  1. Topical Collection on Devices

Abstract

Purpose of Review

His bundle pacing (HBP) has continued to emerge as a viable alternative to both right ventricular pacing (RVP) and cardiac resynchronization therapy. In recent years, a considerable amount of research has been published with regard to using HBP to treat congestive heart failure (CHF) and this article presents a concise yet comprehensive review of this literature.

Recent Findings

Studies have demonstrated that HBP is useful for CHF patients who are non-responders to biventricular pacing (BiVP) or have a history of previously failed coronary sinus lead placement, right/left bundle branch block cardiomyopathy, or pacing-induced cardiomyopathy. Additionally, HBP is useful in patients with an indication for pacing who are expected to have a RVP burden exceeding 20%.

Summary

The theoretical benefit of utilizing the native His Purkinje system to excite cardiac tissue is appealing as it can result in true cardiac resynchronization. Limited studies have shown its benefit in reducing heart failure symptoms and improving cardiac function. Larger randomized clinical trials and further investments into developing better technologies are highly desired to make its clinical use sustainable in the long run.

Keywords

His bundle pacing Cardiac resynchronization therapy Heart failure Cardiac dyssynchrony Pacing-induced cardiomyopathy 

Notes

Compliance with Ethical Standards

Conflict of Interest

Philip L Mar and Subodh R Devabhaktuni each declare no potential conflicts of interest. Gopi Dandamudi is a consultant and on the advisory board for Medtronic, Inc. and on the advisory board for Biotronik, Inc.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Bakker PF, Meijburg HW, de Vries JW, Mower MM, Thomas AC, Hull ML, et al. Biventricular pacing in end-stage heart failure improves functional capacity and left ventricular function. J Interv Card Electrophysiol. 2000;4(2):395–404.CrossRefGoogle Scholar
  2. 2.
    Leclercq C, Cazeau S, Le Breton H, Ritter P, Mabo P, Gras D, et al. Acute hemodynamic effects of biventricular DDD pacing in patients with end-stage heart failure. J Am Coll Cardiol. 1998;32(7):1825–31.CrossRefGoogle Scholar
  3. 3.
    Abraham WT, Fisher WG, Smith AL, Delurgio DB, Leon AR, Loh E, et al. Cardiac resynchronization in chronic heart failure. N Engl J Med. 2002;346(24):1845–53.  https://doi.org/10.1056/NEJMoa013168.CrossRefGoogle Scholar
  4. 4.
    Cleland JG, Daubert JC, Erdmann E, Freemantle N, Gras D, Kappenberger L, et al. The effect of cardiac resynchronization on morbidity and mortality in heart failure. N Engl J Med. 2005;352(15):1539–49.  https://doi.org/10.1056/NEJMoa050496.CrossRefGoogle Scholar
  5. 5.
    Goldenberg I, Kutyifa V, Klein HU, Cannom DS, Brown MW, Dan A, et al. Survival with cardiac-resynchronization therapy in mild heart failure. N Engl J Med. 2014;370(18):1694–701.  https://doi.org/10.1056/NEJMoa1401426.CrossRefGoogle Scholar
  6. 6.
    Moss AJ, Hall WJ, Cannom DS, Klein H, Brown MW, Daubert JP, et al. Cardiac-resynchronization therapy for the prevention of heart-failure events. N Engl J Med. 2009;361(14):1329–38.  https://doi.org/10.1056/NEJMoa0906431.CrossRefGoogle Scholar
  7. 7.
    Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE Jr, Colvin MM, et al. 2017 ACC/AHA/HFSA focused update of the 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America. J Card Fail. 2017;23(8):628–51.  https://doi.org/10.1016/j.cardfail.2017.04.014.CrossRefGoogle Scholar
  8. 8.
    Scherlag BJ, Papaila A. Permanent His bundle pacing to replace biventricular pacing for cardiac resynchronization therapy. Med Hypotheses. 2017;109:77–9.  https://doi.org/10.1016/j.mehy.2017.09.026.CrossRefGoogle Scholar
  9. 9.
    Narula OS. Longitudinal dissociation in the His bundle. Bundle branch block due to asynchronous conduction within the His bundle in man. Circulation. 1977;56(6):996–1006.CrossRefGoogle Scholar
  10. 10.
    Deshmukh P, Casavant DA, Romanyshyn M, Anderson K. Permanent, direct His-bundle pacing: a novel approach to cardiac pacing in patients with normal His-Purkinje activation. Circulation. 2000;101(8):869–77.CrossRefGoogle Scholar
  11. 11.
    Luedorff G, Kranig W, Grove R, Wolff E, Heimlich G, Thale J. Improved success rate of cardiac resynchronization therapy implant by employing an active fixation coronary sinus lead. Europace. 2010;12(6):825–9.  https://doi.org/10.1093/europace/euq078.CrossRefGoogle Scholar
  12. 12.
    • Barba-Pichardo R, Manovel Sanchez A, Fernandez-Gomez JM, Morina-Vazquez P, Venegas-Gamero J, Herrera-Carranza M. Ventricular resynchronization therapy by direct His-bundle pacing using an internal cardioverter defibrillator. Europace. 2013;15(1):83–8.  https://doi.org/10.1093/europace/eus228 This study demonstrated that HBP was a viable strategy for those failing conventional CRT with a coronary sinus lead.CrossRefGoogle Scholar
  13. 13.
    Sharma PS, Dandamudi G, Herweg B, Wilson D, Singh R, Naperkowski A, et al. Permanent His-bundle pacing as an alternative to biventricular pacing for cardiac resynchronization therapy: a multicenter experience. Heart Rhythm. 2018;15(3):413–20.  https://doi.org/10.1016/j.hrthm.2017.10.014.CrossRefGoogle Scholar
  14. 14.
    Ypenburg C, Westenberg JJ, Bleeker GB, VANdV N, Marsan NA, Henneman MM, et al. Noninvasive imaging in cardiac resynchronization therapy--part 1: selection of patients. Pacing Clin Electrophysiol. 2008;31(11):1475–99.  https://doi.org/10.1111/j.1540-8159.2008.01212.x.CrossRefGoogle Scholar
  15. 15.
    Shan P, Su L, Zhou X, Wu S, Xu L, Xiao F, et al. Beneficial effects of upgrading to His bundle pacing in chronically paced patients with left ventricular ejection fraction <50. Heart Rhythm. 2018;15(3):405–12.  https://doi.org/10.1016/j.hrthm.2017.10.031.CrossRefGoogle Scholar
  16. 16.
    Vaillant C, Martins RP, Donal E, Leclercq C, Thebault C, Behar N, et al. Resolution of left bundle branch block-induced cardiomyopathy by cardiac resynchronization therapy. J Am Coll Cardiol. 2013;61(10):1089–95.  https://doi.org/10.1016/j.jacc.2012.10.053.CrossRefGoogle Scholar
  17. 17.
    Vernooy K, Verbeek XA, Peschar M, Crijns HJ, Arts T, Cornelussen RN, et al. Left bundle branch block induces ventricular remodelling and functional septal hypoperfusion. Eur Heart J. 2005;26(1):91–8.  https://doi.org/10.1093/eurheartj/ehi008.CrossRefGoogle Scholar
  18. 18.
    Dreger H, Maethner K, Bondke H, Baumann G, Melzer C. Pacing-induced cardiomyopathy in patients with right ventricular stimulation for >15 years. Europace. 2012;14(2):238–42.  https://doi.org/10.1093/europace/eur258.CrossRefGoogle Scholar
  19. 19.
    Khurshid S, Epstein AE, Verdino RJ, Lin D, Goldberg LR, Marchlinski FE, et al. Incidence and predictors of right ventricular pacing-induced cardiomyopathy. Heart Rhythm. 2014;11(9):1619–25.  https://doi.org/10.1016/j.hrthm.2014.05.040.CrossRefGoogle Scholar
  20. 20.
    Kim JH, Kang KW, Chin JY, Kim TS, Park JH, Choi YJ. Major determinant of the occurrence of pacing-induced cardiomyopathy in complete atrioventricular block: a multicentre, retrospective analysis over a 15-year period in South Korea. BMJ Open 2018;8(2):e019048.  https://doi.org/10.1136/bmjopen-2017-019048.
  21. 21.
    Wilkoff BL, Cook JR, Epstein AE, Greene HL, Hallstrom AP, Hsia H, et al. Dual-chamber pacing or ventricular backup pacing in patients with an implantable defibrillator: the Dual Chamber and VVI Implantable Defibrillator (DAVID) Trial. JAMA. 2002;288(24):3115–23.CrossRefGoogle Scholar
  22. 22.
    Lamas GA, Lee KL, Sweeney MO, Silverman R, Leon A, Yee R, et al. Ventricular pacing or dual-chamber pacing for sinus-node dysfunction. N Engl J Med. 2002;346(24):1854–62.  https://doi.org/10.1056/NEJMoa013040.CrossRefGoogle Scholar
  23. 23.
    Ye Y, Zhang Z, Sheng X, Wang B, Chen S, Pan Y, et al. Upgrade to his bundle pacing in pacing-dependent patients referred for pulse generator change: feasibility and intermediate term follow up. Int J Cardiol. 2018;260:88–92.  https://doi.org/10.1016/j.ijcard.2018.01.105.CrossRefGoogle Scholar
  24. 24.
    Epstein AE, DiMarco JP, Ellenbogen KA, Estes NA 3rd, Freedman RA, Gettes LS, et al. 2012 ACCF/AHA/HRS focused update incorporated into the ACCF/AHA/HRS 2008 guidelines for device-based therapy of cardiac rhythm abnormalities: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. Circulation. 2013;127(3):e283–352.  https://doi.org/10.1161/CIR.0b013e318276ce9b.CrossRefGoogle Scholar
  25. 25.
    Curtis AB, Worley SJ, Adamson PB, Chung ES, Niazi I, Sherfesee L, et al. Biventricular pacing for atrioventricular block and systolic dysfunction. N Engl J Med. 2013;368(17):1585–93.  https://doi.org/10.1056/NEJMoa1210356.CrossRefGoogle Scholar
  26. 26.
    Funck RC, Blanc JJ, Mueller HH, Schade-Brittinger C, Bailleul C, Maisch B. Biventricular stimulation to prevent cardiac desynchronization: rationale, design, and endpoints of the ‘Biventricular Pacing for Atrioventricular Block to Prevent Cardiac Desynchronization (BioPace)’ study. Europace. 2006;8(8):629–35.  https://doi.org/10.1093/europace/eul075.CrossRefGoogle Scholar
  27. 27.
    Wilkoff BL, Kudenchuk PJ, Buxton AE, Sharma A, Cook JR, Bhandari AK, et al. The DAVID (Dual Chamber and VVI Implantable Defibrillator) II trial. J Am Coll Cardiol. 2009;53(10):872–80.  https://doi.org/10.1016/j.jacc.2008.10.057.CrossRefGoogle Scholar
  28. 28.
    • Sharma PS, Dandamudi G, Naperkowski A, Oren JW, Storm RH, Ellenbogen KA, et al. Permanent His-bundle pacing is feasible, safe, and superior to right ventricular pacing in routine clinical practice. Heart Rhythm. 2015;12(2):305–12.  https://doi.org/10.1016/j.hrthm.2014.10.021 This is the first study demonstrating that HBP is safe and feasible in routine clinical practice, with 75 of 94 consecutive patients successfully implanted. This study also compared the results to an RV pacing group only and demonstrated that in a subset of patients with >40% pacing, less heart failure events were seen in the HBP group.CrossRefGoogle Scholar
  29. 29.
    Vijayaraman P, Naperkowski A, Subzposh FA, Abdelrahman M, Sharma PS, Oren JW, et al. Permanent His-bundle pacing: long-term lead performance and clinical outcomes. Heart Rhythm. 2018;2017.  https://doi.org/10.1016/j.hrthm.2017.12.022.
  30. 30.
    • Abdelrahman M, Subzposh FA, Beer D, Durr B, Naperkowski A, Sun H, et al. Clinical outcomes of His bundle pacing compared to right ventricular pacing. J Am Coll Cardiol. 2018.  https://doi.org/10.1016/j.jacc.2018.02.048 This study compared the effects of right ventricular pacing to HBP in patients requiring pacemaker implantation and demonstrated that in patients who received HBP; there was a significant decrease in heart failure hospitalizations and all-cause mortality. The HBP arm of this study represents one of the largest cohorts to date in which permanent HBP was successfully instituted.
  31. 31.
    • Huang W, Su L, Wu S, Xu L, Xiao F, Zhou X, et al. Benefits of permanent His bundle pacing combined with atrioventricular node ablation in atrial fibrillation patients with heart failure with both preserved and reduced left ventricular ejection fraction. J Am Heart Assoc. 2017;6(4).  https://doi.org/10.1161/jaha.116.005309 This study confirmed the feasibility and usefulness of AV node ablation followed by institution of permanent HBP in a sizeable cohort of 52 patients.
  32. 32.
    Vijayaraman P, Subzposh FA, Naperkowski A. Atrioventricular node ablation and His bundle pacing. Europace. 2017;19(suppl_4):iv10–iv6.  https://doi.org/10.1093/europace/eux263.CrossRefGoogle Scholar
  33. 33.
    Sharma PS, Naperkowski A, Bauch TD, Chan JYS, Arnold AD, Whinnet ZI, et al. Permanent His bundle pacing for cardiac resynchronization therapy in patients with heart failure and right bundle branch block. Circ Arrhythm Electrophysiol. 2018;11:e006613.  https://doi.org/10.1161/CIRCEP.118.006613.CrossRefGoogle Scholar
  34. 34.
    Nikolaidou T, Ghosh JM, Clark AL. Outcomes related to first-degree atrioventricular block and therapeutic implications in patients with heart failure. JACC Clin Electroencephalogr. 2016;2(2):181–92.  https://doi.org/10.1016/j.jacep.2016.02.012.CrossRefGoogle Scholar
  35. 35.
    Ali N, Keene D, Arnold A, Shun-Shin M, Whinnett ZI, Afzal Sohaib SM. His bundle pacing: a new frontier in the treatment of heart failure. Arrhythmia Electrophysiol Rev. 2018;7(2):103–10.  https://doi.org/10.15420/aer.2018.6.2.CrossRefGoogle Scholar
  36. 36.
    Sohaib SMA, Wright I, Lim E, Moore P, Lim PB, Koawing M, et al. Atrioventricular optimized direct His bundle pacing improves acute hemodynamic function in patients with heart failure and PR interval prolongation without left bundle branch block. JACC Clin Electroencephalogr. 2015;1(6):582–91.  https://doi.org/10.1016/j.jacep.2015.08.008.CrossRefGoogle Scholar
  37. 37.
    • Ajijola OA, Upadhyay GA, Macias C, Shivkumar K, Tung R. Permanent His-bundle pacing for cardiac resynchronization therapy: initial feasibility study in lieu of left ventricular lead. Heart Rhythm. 2017;14(9):1353–61.  https://doi.org/10.1016/j.hrthm.2017.04.003 This study demonstrated that HBP appears to be an effective pacing strategy for patients with heart failure (ischemic or nonischemic) in need for CRT as an alternative to BiVP.CrossRefGoogle Scholar
  38. 38.
    Dandamudi G, Vijayaraman P. How to perform permanent His bundle pacing in routine clinical practice. Heart Rhythm. 2016;13(6):1362–6.  https://doi.org/10.1016/j.hrthm.2016.03.040.CrossRefGoogle Scholar
  39. 39.
    Vijayaraman P, Dandamudi G. How to perform permanent His bundle pacing: tips and tricks. Pacing Clin Electrophysiol : PACE. 2016;39(12):1298–1304.  https://doi.org/10.1111/pace.12904.
  40. 40.
    Lustgarten DL, Crespo EM, Arkhipova-Jenkins I, Lobel R, Winget J, Koehler J, et al. His-bundle pacing versus biventricular pacing in cardiac resynchronization therapy patients: a crossover design comparison. Heart Rhythm. 2015;12(7):1548–57.  https://doi.org/10.1016/j.hrthm.2015.03.048 This is the only study comparing outcomes of HBP versus BiVP (clinical and echocardiographic) in the same patients (12 total). Patients were both implanted with a His bundle as well as a coronary sinus lead. They were randomized to either 6 months of HBP or BiVP before crossing over to the other pacing strategy. No clinical or echocardiograhic differences were noted.CrossRefGoogle Scholar
  41. 41.
    Su L, Xu L, Wu SJ, Huang WJ. Pacing and sensing optimization of permanent His-bundle pacing in cardiac resynchronization therapy/implantable cardioverter defibrillators patients: value of integrated bipolar configuration. Europace. 2016;18(9):1399–405.  https://doi.org/10.1093/europace/euv306.CrossRefGoogle Scholar
  42. 42.
    Vijayaraman P, Dandamudi G, Worsnick S, Ellenbogen KA. Acute His-bundle injury current during permanent His-bundle pacing predicts excellent pacing outcomes. Pacing Clin Electrophysiol : PACE. 2015;38(5):540–546.  https://doi.org/10.1111/pace.12571.
  43. 43.
    Deshmukh PM, Romanyshyn M. Direct His-bundle pacing: present and future. Pacing Clin Electrophysiol. 2004;27(6 Pt 2):862–70.  https://doi.org/10.1111/j.1540-8159.2004.00548.x.CrossRefGoogle Scholar
  44. 44.
    Kronborg MB, Mortensen PT, Poulsen SH, Gerdes JC, Jensen HK, Nielsen JC. His or para-His pacing preserves left ventricular function in atrioventricular block: a double-blind, randomized, crossover study. Europace. 2014;16(8):1189–96.  https://doi.org/10.1093/europace/euu011.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Philip L. Mar
    • 1
  • Subodh R. Devabhaktuni
    • 1
  • Gopi Dandamudi
    • 1
    • 2
    Email author
  1. 1.Indiana UniversityIndianapolisUSA
  2. 2.CHI FRANCISCANTacomaUSA

Personalised recommendations