Permanent His bundle pacing: shaping the future of physiological ventricular pacing

@article{Sharma2019PermanentHB,
  title={Permanent His bundle pacing: shaping the future of physiological ventricular pacing},
  author={Parikshit S. Sharma and Pugazhendhi Vijayaraman and Kenneth A. Ellenbogen},
  journal={Nature Reviews Cardiology},
  year={2019},
  volume={17},
  pages={22-36}
}
Conventional right ventricular (RV) pacing, particularly RV apical pacing, can have deleterious effects on cardiac function. Long-term RV apical pacing has been associated with increased risk of atrial fibrillation, hospitalization for heart failure, pacing-induced cardiomyopathy and associated death. His bundle pacing (HBP) results in physiological ventricular activation and has generated tremendous research interest and enthusiasm. By stimulating the His–Purkinje network directly, HBP results… Expand

Paper Mentions

Observational Patient Registry Clinical Trial
The aim of this study is to evaluate safety and clinical outcomes after different pacing approaches of conduction system pacing in a prospective registry.  
ConditionsAtrial Fibrillation Rapid, AV Block, Bundle-Branch Block
InterventionProcedure
Left bundle branch pacing is the best approach to physiological pacing
TLDR
In the largest observational, 2center study, 844 patients who received HBP leads had a mean pacing capture threshold of 1.6 V at implant and 2 V at median follow-up of 3 years, and HBP was free of any complications in 91% of patients. Expand
Novel bradycardia pacing strategies
TLDR
Preliminary studies have shown that LBBAP is feasible, safe and encounters less limitations than HBP, and further studies are needed to differentiate between LVSP and LBBP with regard to acute functional and long-term clinical outcome. Expand
Tripartite Left Bundle Branch Area Pacing.
TLDR
A new strategy to directly capture the left ventricle conduction system called left bundle branch area pacing (LBBAP) is first demonstrated, which might be an alternative method for failed HBP cases such as high pacing threshold of the His bundle, infranodal atrioventricular block to show the exit block, or failed correction of left bundles branch block by HBP. Expand
His bundle pacing: initial Slovenian single-centre experience
Background: High right ventricular (RV) pacing burden may promote left ventricular dysfunction. Recently, His bundle pacing (HBP) has emerged as an alternative method to RV pacing that providesExpand
Leadless Left Ventricular Endocardial Pacing and Left Bundle Branch Area Pacing for Cardiac Resynchronisation Therapy
TLDR
LV endocardial pacing and left bundle branch area pacing provides a more physiological activation pattern and may allow effective cardiac resynchronisation and LBBAP, its potential benefits over His bundle pacing and procedural outcomes are discussed. Expand
Bradyarrhythmias and Physiologic Pacing in the ICU.
TLDR
The goal of the review is to examine bradyarrhythmia causes and management in the ICU as well as investigate new approaches in physiologic pacing and their potential roles in critically ill patients. Expand
Pacing induced cardiomyopathy
TLDR
Emerging data suggest that conduction system pacing (CSP) may offer an opportunity to prevent PICM in the first place. Expand
The desire for physiological pacing: Are we there yet?
  • G. Kaye
  • Medicine
  • Journal of cardiovascular electrophysiology
  • 2019
TLDR
The background to the development of physiological pacing is reviewed, historical data for right ventricular pacing is evaluated and the basis for change and new lead positions are evaluated. Expand
Electrical characteristics of pacing different portions of the His bundle in bradycardia patients.
  • Y. Hu, M. Gu, +6 authors Shu Zhang
  • Medicine
  • Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology
  • 2020
TLDR
It is demonstrated that vHBP features a low and stable pacing capture threshold and high R-wave amplitude, suggesting better pacing mode management and battery longevity can be achieved by HBP in the ventricular side. Expand
Comparison of electrical characteristics and pacing parameters of pacing different parts of the His-Purkinje system in bradycardia patients
TLDR
VHBP and LBBP had better pacing performances than aH BP and might be more ideal pacing methods for bradycardia patients and no significant differences were observed in complications among groups during 3-month follow-up. Expand
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References

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His Resynchronization Versus Biventricular Pacing in Patients With Heart Failure and Left Bundle Branch Block
TLDR
A head-to-head, high-precision, acute crossover comparison between His bundle pacing and conventional biventricular CRT, measuring effects on ventricular activation and acute hemodynamic function delivered better ventricular resynchronization, and greater improvement in hemodynamic parameters, than bventricular pacing. Expand
Permanent His-bundle pacing is feasible, safe, and superior to right ventricular pacing in routine clinical practice.
TLDR
Permanent HBP without a mapping catheter or a backup right ventricular lead was successfully achieved in 80% of patients and clinical outcomes were better in the HBP group than in the RVP group. Expand
Permanent His-bundle pacing: Long-term lead performance and clinical outcomes.
TLDR
In patients undergoing pacemaker implantation, permanent HBP was associated with reduction in death or HFH during long-term follow-up compared to RVP, and wasassociated with higher rates of lead revisions and generator change. Expand
Clinical Outcomes of His Bundle Pacing Compared to Right Ventricular Pacing.
TLDR
Permanent HBP was feasible and safe in a large real-world population requiring permanent pacemakers and was associated with reduction in the combined endpoint of death, HFH, or upgrade to BiVP compared to RVP in patients requiring permanentpacemakers. Expand
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TLDR
Permanent para-Hisian pacing is feasible and safe in patients with chronic atrial fibrillation and narrow QRS who underwent atrioventricular (AV) node ablation and allows an improvement in functional and hemodynamic parameters over long-term follow-up. Expand
Permanent His Bundle Pacing for Cardiac Resynchronization Therapy in Patients With Heart Failure and Right Bundle Branch Block
TLDR
Permanent HBP was associated with significant narrowing of QRS duration and improvement in LV function in patients with RBBB and reduced LV ejection fraction and is a promising option for cardiac resynchronization therapy in patientsWith RBBBs and heart failure. Expand
Permanent, direct His-bundle pacing: a novel approach to cardiac pacing in patients with normal His-Purkinje activation.
TLDR
Permanent DHBP is feasible in select patients who have chronic atrial fibrillation and dilated cardiomyopathy and results in a reduction of left ventricular dimensions and improved cardiac function. Expand
Permanent His-bundle pacing: seeking physiological ventricular pacing.
TLDR
In some patients, permanent HBP may be an alternative to right ventricular apical pacing and this paper presents the experience with permanent His-bundle pacing. Expand
His-bundle pacing versus biventricular pacing in cardiac resynchronization therapy patients: A crossover design comparison.
TLDR
In this crossover comparison between HBP and BiVP, HBP was found to effect an equivalent CRT response, suggesting this approach may be feasible in more patients with left bundle branch block than previously assumed. Expand
Permanent His-bundle pacing as an alternative to biventricular pacing for cardiac resynchronization therapy: A multicenter experience.
TLDR
Permanent His-bundle pacing may be considered as a rescue strategy for failed BVP and may be a reasonable primary alternative to BVP for CRT. Expand
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