Department of Cardiology, University Hospital of Geneva, Geneva, Switzerland.
Almazov National Medical Research Center, Saint-Petersburg, Russia.
JACC Clin Electrophysiol. 2021 Jul;7(7):881-892. doi: 10.1016/j.jacep.2020.11.029. Epub 2021 Feb 24.
This study sought to evaluate the effectiveness of His-optimized cardiac resynchronization therapy (HOT-CRT) for reducing left ventricular activation time (LVAT) compared to His bundle pacing (HBP) and biventricular (BiV) pacing (including multipoint pacing [MPP]), using electrocardiographic (ECG) imaging.
HBP may correct bundle branch block (BBB) and has shown encouraging results for providing CRT. However, HBP does not correct BBB in all patients and may be combined with univentricular or BiV fusion pacing to deliver HOT-CRT to maximize resynchronization.
Nineteen patients with a standard indication for CRT, implanted with HBP without correction of BBB and BiV (n = 14) or right ventricular (n = 5) leads, were prospectively enrolled. Patients underwent ECG imaging while pacing in different configurations using different LV electrodes and at different HBP ventricular pacing (VP) delays. The primary endpoint was reduction in LVAT with HOT-CRT, and the secondary endpoints included various other dys-synchrony measurements including right ventricular activation time (RVAT).
Compared to HBP, HOT-CRT reduced LVAT by 21% (-17 ms [95% confidence interval [CI]: -25 to -9 ms]; p < 0.001) and outperformed BiV by 24% (-22 ms [95% CI: -33 to -10 ms]; p = 0.002) and MPP by 13% (-11 ms [95% CI: -21 to -1 ms]; p = 0.035). Relative to HBP, HOT-CRT also reduced RVAT by 7% (-5 ms [95% CI: -9 to -1 ms; p = 0.035) in patients with right BBB, whereas RVAT was increased by BiV. The other electrical dyssynchrony measurements also improved with HOT-CRT.
HOT-CRT acutely improves ventricular electrical synchrony beyond BiV and MPP. The impact of this finding needs to be evaluated further in studies with clinical follow-up. (Electrical Resynchronization and Acute Hemodynamic Effects of Direct His Bundle Pacing Compared to Biventricular Pacing; NCT03452462).
本研究旨在通过心电图（ECG）成像评估与希氏束起搏（HBP）和双心室（BiV）起搏（包括多点起搏[MPP]）相比，优化心脏再同步治疗（HOT-CRT）减少左心室激活时间（LVAT）的有效性。
HBP 可纠正束支传导阻滞（BBB），并为提供 CRT 提供了令人鼓舞的结果。然而，HBP 并不能纠正所有患者的 BBB，并且可能与单心室或 BiV 融合起搏相结合，以最大限度地实现再同步化来提供 HOT-CRT。
前瞻性纳入 19 例符合 CRT 标准的患者，植入 HBP 时未纠正 BBB 和 BiV（n=14）或右心室（n=5）导线。患者在不同配置下起搏时接受 ECG 成像，使用不同的 LV 电极和不同的 HBP 心室起搏（VP）延迟。主要终点是 HOT-CRT 减少 LVAT，次要终点包括各种其他不同步测量，包括右心室激活时间（RVAT）。
与 HBP 相比，HOT-CRT 减少 LVAT 21%（-17ms[95%置信区间[CI]：-25 至-9ms]；p<0.001），优于 BiV 24%（-22ms[95%CI：-33 至-10ms]；p=0.002）和 MPP 13%（-11ms[95%CI：-21 至-1ms]；p=0.035）。与 HBP 相比，HOT-CRT 还减少了右 BBB 患者的 RVAT 7%（-5ms[95%CI：-9 至-1ms；p=0.035），而 BiV 则增加了 RVAT。其他电不同步测量也随着 HOT-CRT 而改善。
HOT-CRT 急性改善了心室电同步性，优于 BiV 和 MPP。需要进一步在具有临床随访的研究中评估这一发现的影响。（直接希氏束起搏与双心室起搏的电再同步和急性血液动力学效果比较；NCT03452462）。
