Efficacy of His Bundle Pacing on LV Relaxation and Clinical Improvement in HF and LBBB
Efficacy of His Bundle Pacing on LV Relaxation and Clinical Improvement in HF and LBBB
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DOI：
10.1016/j.jacep.2021.06.011
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发表时间：
2022-01-17
影响因子：
7
通讯作者：
Murohara, Toyoaki
中科院分区：
文献类型：
--
作者：
Kato, Hiroyuki;Yanagisawa, Satoshi;Murohara, Toyoaki
目的比较希氏束起搏(HBP)和常规双室起搏(BVP)对左束支传导阻滞(LBBB)的急性血流动力学改善及疗效。比较CRT前插入左心室(LV)的微压计导管对HBP和BVP的急性血流动力学反应的影响。将每种配置与AAI模式进行比较。当LBBB矫正阈值为#1.5 VAT 1.0ms时，植入永久性HBP装置，其余患者接受BVP治疗。结果两组患者的左心室收缩指数(左心室最大压力上升率[dp/dtmax])无明显差异(18.8%+/-6.4%vs18.0%+/-10.2%；P=0.810)。左室舒张指数(负dp/dtmax和tau)明显改善(负dp/dtmax：14.3%+/-5.5%vs 3.1%+/-8.1%；P<；0.001；tau：7.2%+/-4.3%vs-0.8%+/-8.1%；P=0.001)。9例(%)患者接受了永久性HBP装置治疗，5例患者接受了BVP治疗。接受HBP和BVP治疗的患者的纽约心脏协会功能分级、左心室射血分数、左心室收缩末期容量和B型利钠肽水平均有改善(均P<；0.05与基线相比)。与BVP组相比，HBP组患者的左心室射血分数和左心室收缩末期容量的改善更早、更明显。结论HBP改善了心力衰竭和LBBB患者的收缩功能和左室舒张功能。与BVP相比，经HBP行CRT的临床反应更早、更明显。(C)2022年，由美国心脏病学会基金会提供。
OBJECTIVES This study aimed to compare acute hemodynamic improvements and responses to His bundle pacing (HBP) and conventional biventricular pacing (BVP).BACKGROUND HBP can correct left bundle branch block (LBBB) and may be an alternative cardiac resynchronization therapy (CRT) to BVP.METHODS Fourteen consecutive patients with heart failure (HF) and typical LBBB who required CRT were enrolled. The acute hemodynamic responses during HBP and BVP were compared using a micromanometer-tipped catheter inserted into the left ventricle (LV) before CRT. Each configuration was compared with AAI mode. A permanent HBP device was implanted when LBBB correction threshold was #1.5 Vat 1.0 ms, and remaining patients were treated with BVP. Clinical and echocardiographic improvements were assessed during a 12-month follow-up period.RESULTS The LV contractile index (positive maximal rate of LV pressure rise [dP/dtmax]) increased similarly during HBP and BVP (18.8% +/- 6.4% vs 18.0% +/- 10.2%; P = 0.810). LV relaxation indices (negative dP/dtmax and tau) were significantly improved during HBP compared with BVP (negative dP/dtmax: 14.3% +/- 5.5% vs 3.1% +/- 8.1%; P < 0.001; tau: 7.2% +/- 4.3% vs-0.8% +/- 8.1%; P = 0.001). Nine (64%) patients received permanent HBP devices, while 5 patients were treated with BVP. The New York Heart Association functional class, LV ejection fraction, LV end-systolic volume, and B-type natriuretic peptide level improved in patients treated with HBP and BVP (all P < 0.05 vs baseline). Patients treated with HBP exhibited earlier and greater improvements of the LV ejection fraction and LV end-systolic volume than did those with BVP.CONCLUSIONS HBP improves systolic function and LV relaxation in patients with HF and LBBB. CRT via HBP produced earlier and greater clinical responses than BVP. (C) 2022 by the American College of Cardiology Foundation.