The application of His bundle pacing in patients with heart failure and His-Purkinje conduction disease

Abstract

Objective To investigate the feasibility and short-term outcomes in clinical application of His bundle pacing (HBP) as the first-choice treatment for patients with heart failure (HF) and His-Purkinje conduction disease (HPCD) . Methods The patients with cardiac resynchronization therapy (CRT) indications and HPCD from March 2016 to December 2017 in General Hospital of Shenyang Military Region were enrolled in this study. All patients agreed that HBP serves as the first-choice treatment for HPCD correction. The success rate of HPCD correction, pacing parameter, pacing performance and short-term clinical effect of HBP were analyzed and HBP electrocardiogram (ECG) were compared with baseline ECG and biventricular pacing (BVP) performance in atrial fibrillation (AF) patients . Based on the different HBP type of HPCD correction, the patients were divided into group of selective HBP (S-HBP) and group of non-selective HBP (NS-HBP) .The relevant parameters of the ECG were compared between the two groups and the baseline seperately. Results Among 18 patients, AF was diagnosed in 11 patients. Eight of the 11 patients had left bundle branch block (LBBB) and 3 of them had right bundle branch block (RBBB) . The other 7 patients were diagnosed as sinus rhythm with LBBB. The average duration of QRS complex was 150-180 (170±11) ms, mean left ventricular ejection fraction (LVEF) was 19%-35% (27%±5%) . The total success rate of HBP as the first-choice treatment of correcting HPCD was 89% (16/18) and the pacing threshold for HPCD correction was 0.8-1.8 (1.4±0.3) V/1.0 ms. Mean fluoroscopy time for HBP lead implantation was 2.0-13.6 (6.8±3.0) min. The QRS duration of HBP was significantly shorter than intrinsic QRS duration [85-135 (103±18) ms vs. 150-180 (167±11) ms, P<0.01] . The QRS duration of S-HBP was significantly shorter than the QRS duration of NS-HBP after HPCD correction [ (92±4) ms vs. (132±6) ms, P<0.01] . Eight patients with AF were simultaneously implanted with a HBP lead and a left ventricle lead via coronary sinus simultaneously. Fluoroscopy time for HBP lead implantation was markedly shorter than left ventricle lead implantation [3.8-12.2 (6.9±2.6) min vs. 10.2-39.8 (22.8±9.5) min, P<0.01] . The QRS duration of HBP was significantly shorter than QRS duration of BVP in these 8 patients [90-135 (111±19) ms vs.125-140 (133±5) ms, P=0.02] . One month after HBP, LVEF was significantly increased [23%-47% (37%±6%) vs. 19%-35% (27%±5%) , P<0.01] . Conclusions HBP as the first-choice treatment for correcting cardiac desynchronization caused by HPCD in HF patients was feasible and the short-term outcome was improved significantly. Key words: Heart failure; His bundle pacing; His Purkinje system