Paradigm shift in the world of pacing
His Resynchronization Versus Biventricular Pacing in Patients With Heart Failure and Left Bundle Branch Block. DOI: 10.1016/j.jacc.2018.09.073
Transveinous cardiac pacing has been around for several decades and although life-saving in patients with no intrinsic heart rhythm, the adverse consequences of chronic pacing has been known for a long time. Placement of a ventricular lead in RV (right ventricular) apex leads to a dyssynchronous cardiac contraction with LBBB (left bundle branch block) on ECG which can lead to pacing-induced cardiomyopathy, atrial fibrillation and heart failure.
Cardiac resynchronization therapy (CRT, biventricular pacing) overcomes these shortcoming of conventional bradycardic pacing but it is a complex, cumbersome and more expensive procedure with higher complication rate than simple RV pacing.
Fortunately, several groups looked into the concept of His bundle pacing which restores normal physiological electrical activation of the heat, eliminates need for another lead and potential for pacing-induced cardiomyopathy. The results of one of the registries are presented in the JACC.
The authors compared His bundle pacing and biventricular pacing in patients with heart failure and LBBB. His bundle pacing provided better resynchronization than biventricular pacing, with greater reductions in QRS duration, LV activation time and LV dyssynchrony and with better acute haemodynamic response.
His bundle pacing was therefore superior to biventricular pacing and at the same time it is less expensive and less complicated. His bundle pacing is technically challenging procedure but once the technique and material are optimized, it is poised to become a procedure of choice for most pacing indications.