Open AccessImprovement of Left Ventricular Function by Permanent Direct His‐Bundle Pacing in a Case with Dilated Cardiomyopathy
Author(s) -
Sashida Yukiko,
Mori Fumiaki,
Arashi Hiroyuki,
Hosaka Fumitaka,
Itai Tsutomu,
Ohnishi Satoshi
Publication year - 2006
Publication title -
journal of arrhythmia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.463
H-Index - 21
eISSN - 1883-2148
pISSN - 1880-4276
DOI - 10.1016/s1880-4276(06)80035-9
Subject(s) - medicine , cardiology , ejection fraction , heart failure , dilated cardiomyopathy , bradycardia , cardiomyopathy , tachycardia , heart rate , blood pressure
The patient was a 67‐year‐old female diagnosed with dilated cardiomyopathy. She had chronic atrial fibrillation (AF) with bradycardia and low left ventricular function (left ventricular ejection fraction (LVEF) 40%). She was admitted for congestive heart failure. She remained New York Heart Association (NYHA) functional class III due to AF bradycardia. Pacemaker implantation was necessary for treatment of heart failure and administration of dose intensive β‐blockers. As she had normal His‐Purkinje activation, we examined the optimal pacing sites. Hemodynamics of His‐bundle pacing and biventricular pacing were compared. Pulmonary capillary wedge pressure (PCWP) was significantly lower on Hisbundle pacing than right ventricular (RV) apical pacing and biventricular pacing (13mmHg, 19mmHg, and 19mmHg, respectively) with an almost equal cardiac index. Based on the examination we implanted a permanent pacemaker for Direct His‐bundle pacing (DHBP). After the DHBP implantation, the LVEF immediately improved from 40% to 55%, and BNP level decreased from 422 pg/ml to 42 pg/ml. The number of premature ventricular complex (PVC) was decreased, and non sustained ventricular tachycardia (NSVT) disappeared. Pacing threshold for His‐bundle pacing has remained at the same level. His‐bundle pacing has been maintained during 27 months and her long‐term DHBP can improve cardiac function and the NYHA functional class.