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Heart failure and cardiomyopathies
Original research article
Long-term outcomes of His bundle pacing in patients with heart failure with left bundle branch block
  1. Weijian Huang1,2,
  2. Lan Su1,2,
  3. Shengjie Wu1,2,
  4. Lei Xu1,2,
  5. Fangyi Xiao1,2,
  6. Xiaohong Zhou3,
  7. Guangyun Mao4,
  8. Pugazhendhi Vijayaraman5,
  9. Kenneth A Ellenbogen6
  1. 1 Department of Cardiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
  2. 2 The Key Lab of Cardiovascular Disease of Wenzhou, Wenzhou, China
  3. 3 CRHF Division, Medtronic plc, Mounds View, Minnesota, USA
  4. 4 Department of Preventive Medicine, School of Public Health, Wenzhou Medical University, Wenzhou, China
  5. 5 Cardiac Electrophysiology, Geisinger Heart Institute, Wilkes Barre, Pennsylvania, USA
  6. 6 Department of Cardiology, Virginia Commonwealth University Health System, Richmond, Virginia, USA
  1. Correspondence to Dr Weijian Huang, Department of Cardiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China; weijianhuang69{at}126.com

Abstract

Objectives His bundle pacing (HBP) can potentially correct left bundle branch block (LBBB). We aimed to assess the efficacy of HBP to correct LBBB and long-term clinical outcomes with HBP in patients with heart failure (HF).

Methods This is an observational study of patients with HF with typical LBBB who were indicated for pacing therapy and were consecutively enrolled from one centre. Permanent HBP leads were implanted if the LBBB correction threshold was <3.5V/0.5 ms or 3.0 V/1.0 ms. Pacing parameters, left ventricular ejection fraction (LVEF), left ventricular end-systolic volume (LVESV) and New York Heart Association (NYHA) Class were assessed during follow-up.

Results In 74 enrolled patients (69.6±9.2 years and 43 men), LBBB correction was acutely achieved in 72 (97.3%) patients, and 56 (75.7%) patients received permanent HBP (pHBP) while 18 patients did not receive permanent HBP (non-permanent HBP), due to no LBBB correction (n=2), high LBBB correction thresholds (n=10) and fixation failure (n=6). The median follow-up period of pHBP was 37.1 (range 15.0–48.7) months. Thirty patients with pHBP had completed 3-year follow-up, with LVEF increased from baseline 32.4±8.9% to 55.9±10.7% (p<0.001), LVESV decreased from a baseline of 137.9±64.1 mL to 52.4±32.6 mL (p<0.001) and NYHA Class improvement from baseline 2.73±0.58 to 1.03±0.18 (p<0.001). LBBB correction threshold remained stable with acute threshold of 2.13±1.19 V/0.5 ms to 2.29±0.92 V/0.5 ms at 3-year follow-up (p>0.05).

Conclusions pHBP improved LVEF, LVESV and NYHA Class in patients with HF with typical LBBB.

  • pacemakers
  • heart failure
  • cardiac arrhythmias and resuscitation science

https://doi.org/10.1136/heartjnl-2018-313415

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    Footnotes

    • Contributors Each author listed in the manuscript has contributed significantly to the submitted work. Conception and design: WH, LS. Analysis and interpretation of data: WH, SW, LX, GM. Drafting of the manuscript and revising it critically for important intellectual content: SW, FX, XZ, PV, KAE. Final approval of the manuscript submitted: WH, LS, SW. All authors approved the final version of the paper.

    • Funding Major Project of the Science and Technology of Wenzhou (ZS2017010).

    • Competing interests XZ is an employee of Medtronic plc. PV and KAE are consultants, investigators and receive honoraria from Medtronic plc.

    • Patient consent Obtained.

    • Ethics approval The study protocol was approved by the Institutional Review Board of the First Affiliated Hospital of Wenzhou Medical University.

    • Provenance and peer review Not commissioned; externally peer reviewed.