Electrical resynchronization induced by direct His-bundle pacing
Electrical resynchronization induced by direct His-bundle pacing
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DOI：
10.1016/j.hrthm.2009.09.066
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发表时间：
2010-01-01
期刊：
影响因子：
5.5
通讯作者：
Spector, Peter S.
中科院分区：
文献类型：
--
作者：
Lustgarten, Daniel L.;Calame, Susan;Spector, Peter S.
背景：用于心脏再同步治疗的双室起搏(Biv)在技术上是困难的，并且在30%到40%的患者中不能引起临床反应。理论上，直接希氏束起搏(DHBP)可以避免其中一些问题。虽然DHBP能够缩小部分患者的QRS，但实现这一目标的一致性尚未得到表征。目的本研究的目的是在连续接受临床强制心脏再同步治疗的患者中恢复His-Purkinje功能。比较自然传导、DHBP和Biv QRS时限。所有接受BIV心脏再同步化治疗的患者都符合研究条件。结果10例患者均成功实施DHBP。在10例患者中，7例DHBP较自然传导和Biv显著缩小QRS(平均QRS时限：自然171+/-13ms，DHBP 148+/-11ms，Biv 158+/-21，P
BACKGROUND Biventricular pacing (BiV) to effect cardiac resynchronization therapy can be technically difficult and fails to elicit a clinical response in 30% to 40% of patients. Direct His-bundle pacing (DHBP) theoretically could obviate some of these problems. Although DHBP is capable of narrowing the QRS in some patients, the consistency with which this can be achieved has not been characterized.OBJECTIVE The purpose of this study was to restore His-Purkinje functionality in consecutive patients undergoing de novo clinically mandated cardiac resynchronization therapy.METHODS DHBP was temporarily implemented at the time of implantation of a permanent BiV system in patients referred for cardiac resynchronization therapy. Native conduction, DHBP, and BiV QRS duration were compared. All patients presenting for BiV cardiac resynchronization therapy were eligible for the study. Ten patients were studied.RESULTS DHBP was successfully implemented in all 10 patients. In 7 of 10 patients, DHBP narrowed the QRS significantly compared with native conduction and BiV (mean QRS duration: native 171 +/- 13 ms, DHBP 148 +/- 11 ms, BiV 158 +/- 21, P