期刊
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY
卷 72, 期 24, 页码 3112-3122出版社
ELSEVIER SCIENCE INC
DOI: 10.1016/j.jacc.2018.09.073
关键词
biventricular pacing; cardiac resynchronization therapy; ECGI; His bundle pacing; His resynchronization therapy; noninvasive epicardial mapping
资金
- British Heart Foundation [FS/13/44/30291, FS/14/27/30752, FS/15/53/31615, FS 04/079]
- Wellcome Trust [212183/Z/18/Z]
- NIHR Imperial Biomedical Research Centre (BRC) [P74166]
- Coronary Flow Trust
- Foundation for Circulatory Health
- Medtronic
- Boston Scientific
- MRC [G1000326] Funding Source: UKRI
BACKGROUND His bundle pacing is a new method for delivering cardiac resynchronization therapy (CRT). OBJECTIVES The authors performed a head-to-head, high-precision, acute crossover comparison between His bundle pacing and conventional biventricular CRT, measuring effects on ventricular activation and acute hemodynamic function. METHODS Patients with heart failure and left bundle branch block referred for conventional biventricular CRT were recruited. Using noninvasive epicardial electrocardiographic imaging, the authors identified patients in whom His bundle pacing shortened left ventricular activation time. In these patients, the authors compared the hemodynamic effects of His bundle pacing against biventricular pacing using a high-multiple repeated alternation protocol to minimize the effect of noise, as well as comparing effects on ventricular activation. RESULTS In 18 of 23 patients, left ventricular activation time was significantly shortened by His bundle pacing. Seventeen patients had a complete electromechanical dataset. In them, His bundle pacing was more effective at delivering ventricular resynchronization than biventricular pacing: greater reduction in QRS duration (-18.6 ms; 95% confidence interval [CI]: -31.6 to -5.7 ms; p = 0.007), left ventricular activation time (-26 ms; 95% CI: -41 to -21 ms; p = 0.002), and left ventricular dyssynchrony index (-11.2 ms; 95% CI: -16.8 to -5.6 ms; p < 0.001). His bundle pacing also produced a greater acute hemodynamic response (4.6 mm Hg; 95% CI: 0.2 to 9.1 mm Hg; p = 0.04). The incremental activation time reduction with His bundle pacing over biventricular pacing correlated with the incremental hemodynamic improvement with His bundle pacing over biventricular pacing (R = 0.70; p = 0.04). CONCLUSIONS His resynchronization delivers better ventricular resynchronization, and greater improvement in hemodynamic parameters, than biventricular pacing. (c) 2018 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation.
作者
我是这篇论文的作者
点击您的名字以认领此论文并将其添加到您的个人资料中。
推荐
暂无数据