Affiliation:
1. Department of Cardiology, Copenhagen University Hospital, Rigshospitalet , Co penhagen , Denmark
2. Department of Clinical Medicine, University of Copenhagen , Copenhagen , Denmark
Abstract
Abstract
Aims
His-bundle pacing has emerged as a novel method to deliver cardiac resynchronization therapy (CRT). However, there are no data comparing conventional biventricular (BiV)-CRT with His-CRT with regard to effects on mechanical dyssynchrony and longitudinal contractile function.
Methods and results
Patients with symptomatic heart failure, left ventricular ejection fraction ≤ 35%, and left bundle branch block (LBBB) by strict ECG criteria were randomized 1:1 to His-CRT or BiV-CRT. Two-dimensional strain echocardiography was performed prior to CRT implantation and at 6 months after implantation. Differences in changes in mechanical dyssynchrony (standard deviation of time-to-peak in 12 midventricular and basal segments) and regional longitudinal strain in the six left ventricular walls were compared between the BiV-CRT and His-CRT groups.
In the on-treatment analysis, 31 received BiV-CRT and 19 His-CRT. In both groups, mechanical dyssynchrony was significantly reduced after 6 months [BiV group from 120 ms (±45) to 63 ms (±22), P < 0.001, and His group from 116 ms (±54) to 49 ms (±11), P < 0.001] but no significant differences in changes could be demonstrated between groups [−9.0 ms (−36; 18), P = 0.50]. Global longitudinal strain (GLS) improved in both groups [BiV group from −9.1% (±2.7) to −10.7% (±2.6), P = 0.02, and His group from −8.6% (±2.1) to −11.1% (±2.0), P < 0.001], but no significant differences in changes could be demonstrated from baseline to follow-up [−0.9% (−2.4; −0.6), P = 0.25] between groups. There were no regional differences between groups.
Conclusion
In heart failure, patients with LBBB, BiV-CRT, and His-CRT have comparable effects with regard to improvements in mechanical dyssynchrony and longitudinal contractile function.
Publisher
Oxford University Press (OUP)
Subject
Cardiology and Cardiovascular Medicine,Radiology, Nuclear Medicine and imaging,General Medicine
Cited by
2 articles.
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