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His Bundle Pacing plus LV lead in heart failure patients candidate to CRT

Session Rapid Fire 5: improving the response to cardiac resynchronization therapy: emerging technologies

Speaker Lina Marcantoni

Congress : EHRA 2019

  • Topic : arrhythmias and device therapy
  • Sub-topic : Cardiac Resynchronization Therapy
  • Session type : Rapid Fire Abstracts
  • FP Number : 927

Authors : L Marcantoni (Rovigo,IT), M Zuin (Rovigo,IT), G Pastore (Rovigo,IT), E Baracca (Rovigo,IT), C Picariello (Rovigo,IT), S Aggio (Rovigo,IT), S Giatti (Rovigo,IT), A Maddalozzo (Rovigo,IT), K D'elia (Rovigo,IT), M Carraro (Rovigo,IT), D Lanza (Rovigo,IT), P Galasso (Rovigo,IT), L Roncon (Rovigo,IT), F Zanon (Rovigo,IT)

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Authors:
L Marcantoni1 , M Zuin2 , G Pastore3 , E Baracca3 , C Picariello2 , S Aggio2 , S Giatti2 , A Maddalozzo2 , K D'elia2 , M Carraro2 , D Lanza2 , P Galasso2 , L Roncon2 , F Zanon3 , 1General Hospital of Rovigo, electrophysiology - Rovigo - Italy , 2General Hospital of Rovigo, Cardiology - Rovigo - Italy , 3General Hospital of Rovigo, Electrophysiology - Rovigo - Italy ,

Citation:

Introduction: His-bundle pacing (HBP) can recruit latent His-Purkinje tissue in BBB patients resulting in QRS narrowing/normalization thus shortening the LV electrical delay. Pacing from LV can complete this delay's reduction. Recently HBP has been evaluated as an alternative of CRT with positive results.

Objective:The purpose of this study was to assess the clinical, echo and QRS response to permanent HBP added to standard LV pacing in CRT-indicated patients.

Methods: we rectrospectively analyzed 27 patients (mean age 76±7 years; 19 males) with standard indication for cardiac resynchronization therapy. Basal mean QRS duration was 155±29 ms, basal mean EF 30±5% and basal mean NYHA class 2.8±0.5. AV-block was present in 7 (26%) patients. All patients received the lead in the hisian area (15 S-HBP and 12 NS-HBP) and the LV lead via coronary sinus (0 MPP). 14 patients (52%) had ischemic cardiopathy; 22 patients (81%) had hypertension, 13 patients (48%) had diabetes and 5 (18%) patients had severe kidney disease. A CRT-D device with coil in the RV apex or septum was implanted in 4 patients; in these cases HB lead was plugged into the atrial port. The remaining patients received CRT-P devices with HB lead plugged in the RV port. We set V-V interval to 0 ms. 

Results: All the patients were checked yearly with in-clinic visit and echo. Mean follow-up was 4.2±2.8 years. At the end of follow up mean QRS duration was 131.4±22 ms (P 0.03); mean EF 39±10% (P 0.003).  9 (33%) patients were classified as "super-responders"with final EF =45%. In two cases EF decreased. Median VP was >99%. 11 patients showed an high burden of AT/AF (>50%). The mean longevity of the devices was 4.1±1.5 years. During the first year of follow-up 4 patients (15%) patients experienced heart failure episodes.

Conclusion: HBP associated to LV pacing in HF patients showed a positive effect in cardiac remodelling. 71% patients resulted "responders"and 33% "super-responders"with a final EF=45%. QRS duration and clinical outcomes significantly improved.



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