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Additional benefits of nonconventional modalities of cardiac resynchronization therapy using His bundle pacing
Author(s) -
Coluccia Giovanni,
Vitale Elena,
Corallo Serena,
Aste Milena,
Odaglia Federica,
Donateo Paolo,
Oddone Daniele,
Brignole Michele
Publication year - 2020
Publication title -
journal of cardiovascular electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.193
H-Index - 138
eISSN - 1540-8167
pISSN - 1045-3873
DOI - 10.1111/jce.14359
Subject(s) - medicine , cardiac resynchronization therapy , cardiology , qrs complex , ventricular dyssynchrony , coronary sinus , speckle tracking echocardiography , heart failure , ejection fraction
Abstract Introduction Dyssynchrony persists in many patients despite cardiac resynchronization therapy (CRT). Aim of this proof‐of‐concept study was to achieve better CRT, with a QRS approximating the normal width and axis, by using His bundle pacing (HBP) and nonconventional pacing configurations. Methods and Results In 20 patients with CRT indications, we performed an acute intrapatient comparison between conventional biventricular (CONV) and three nonconventional pacing modalities: HBP alone, His bundle, and coronary sinus pacing (HBP + CS), and HBP + CS plus right ventricular pacing (TRIPLE). Electrical dyssynchrony was assessed by means of QRS width and axis; “quasi‐normal” axis meant an R / S ratio ≥ 1 in leads I and V6 and ≤1 in V1. Mechanical dyssynchrony was assessed by speckle tracking echocardiography. QRS width was 153 ± 18 ms on CONV, shortened to 137 ± 16 ms on HBP + CS ( P = .001) and to 130 ± 14 ms on TRIPLE ( P = .001), while it remained unchanged on HBP (159 ± 32 ms; P = .17). The rate of patients with “quasi‐normal” axis was 5% on CONV, and increased to 90% on HBP ( P = .0001), to 63% on HBP + CS ( P = .001), and to 44% on TRIPLE ( P = .02). On radial strain analysis, the time‐to‐peak difference between anteroseptal and posterolateral segments was 143 ± 116 ms on CONV, shortened to 121 ± 127 ms on HBP ( P = .79), to 67 ± 70 ms on HBP + CS ( P = .02), and to 76 ± 55 ms on TRIPLE ( P = .05). On discharge, HBP was chosen in 15% of patients, HBP + CS in 55%, and TRIPLE in 30%; CONV was never chosen. Conclusion Nonconventional modalities of CRT provide acute additional electrical and mechanical resynchronization. An interpatient variability exists.