Overview of Electrophysiological and Echocardiographic Findings and Outcomes with His Bundle Pacing for Cardiac Resynchronization
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Purpose of Review
His bundle pacing (HBP) is gaining popularity as a therapy for cardiac conduction disease. Utilization of the conduction system with HBP avoids the adverse effects of right ventricular pacing (RVP). Improvements in left ventricular (LV) function, New York Heart Association (NYHA) functional class, and quality of life (QOL) accompanying physiological activation induced by HBP attract attention. This is particularly important given the 30% non-responder rate from cardiac resynchronization therapy (CRT) studies; large number of patients with or at risk for pacing-induced cardiomyopathy and patients with poor coronary sinus (CS) targets.
The advantages of HBP as an alternative method for resynchronizing failing ventricles are supported by several recent studies, which are detailed in this review. HBP had significant clinical benefits in terms of LV ejection fraction (LVEF), NYHA functional class, and diuretic use. A growing number of case reports from several centers also support this growing trend. Additionally, success rates of in correcting bundle branch block have been reported in a number of studies and appear similar to traditional BiV pacing.
HBP is an attractive alternative to CRT in patients with heart failure and electrical conduction abnormalities. With improvements in guide-catheter design, lead structure, and overall operator experience, increased use and improved outcomes are expected in the next decade.
KeywordsHis bundle pacing RV pacing BiV pacing Cardiomyopathy
This work was supported by a Nihon Kohden/St. Jude Medical Research Fellowship to KY and National Institutes of Health grants HL125730 and DP2HL 142045 to OAA.
Compliance with Ethical Standards
Conflict of Interest
Koji Yoshie, and Olujimi A. Ajijola declare that they have no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by the any of the authors.
Papers of particular interest, published recently, have been highlighted as: •• Of major importance
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