Direct His bundle pacing an alternative to biventricular pacing?

Direct His bundle pacing an alternative to biventricular pacing?

Direct His bundle pacing an alternative to biventricular pacing? Daniel L Lustgarten, Susan Calame, Eric M Crespo, James Calame, Robert Lobel and Peter S Spector evaluated the efficacy of direct His bundle pacing vis-a-vis biventricular pacing [1]. All the ten subjects of the study were candidates for cardiac resynchronization therapy (CRT). Direct His bundle pacing (DHBP) was temporarily implemented just prior to biventricular (BiV) pacing in those who were being taken up for cardiac resynchronization therapy. The QRS duration during native conduction, DHBP and BiV were compared. QRS duration was significantly narrower in DHBP than in native conduction or BiV in seven out ten patients (mean QRS duration: native 171 ± 13 ms, DHBP 148 ± 11 ms, BiV 158 ± 21, P <.0001). The lead implantation time was 16 minutes for DHBP while it was 42 minutes for BiV. The authors conclude that DHBP may offer a physiologic alternative to biventricular pacing for CRT.

Daniel L Lustgarten, Eric M Crespo, Irina Arkhipova-Jenkins, Robert Lobel, Joseph Winget, Jodi Koehler, Evan Liberman and Todd Sheldon did a crossover comparison of His bundle pacing vs biventricular pacing [2]. Patients received a right atrial pacing lead, defibrillation lead and left ventricular pacing lead through the coronary sinus as well as a His bundle pacing lead. His bundle leads and left ventricular leads were plugged into the left ventricular port using a Y-adaptor. After the implantations patients were randomized into His bundle pacing or biventricular pacing. After the initial 6 months, patients crossed over to the other pacing modality. Twelve of the 21 patients who had achieved electrical synchronization at implant of the total 29 patients completed the 1 year cross over analysis. Both modalities had an equivalent response.

Reference

  1. Daniel L Lustgarten, Susan Calame, Eric M Crespo, James Calame, Robert Lobel, Peter S Spector. Electrical resynchronization induced by direct His-bundle pacing. Heart Rhythm. 2010 Jan;7(1):15-21.
  2. Daniel L Lustgarten, Eric M Crespo, Irina Arkhipova-Jenkins, Robert Lobel, Joseph Winget, Jodi Koehler, Evan Liberman, Todd Sheldon. His-bundle pacing versus biventricular pacing in cardiac resynchronization therapy patients: A crossover design comparison. Heart Rhythm. 2015 Jul;12(7):1548-57.