Keeping Pace: His-Bundle CRT for Heart Failure Impresses in
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Cardiac resynchronisation therapy (CRT) in patients with symptomatic heart failure and left bundle branch block (LBBB) can be achieved with His-bundle pacing correcting the bundle branch block (His-CRT). The present study is the largest randomised study between His-CRT and biventricular pacing (BiV-CRT) to date.

Fifty patients with symptomatic heart failure, LVEF less than 35% and LBBB on ECG criteria were randomized 1:1 to either His-CRT or BiV-CRT and followed for 6 months. At implantation, seven patients crossed over from His-pacing to LV-pacing in the His-CRT group and one patient crossed over from LV-pacing to His-pacing in the BiV-CRT group.

His-corrective pacing was achieved in 72% of the patients in the His-CRT group. Intention-to-treat 6-month follow-up LVEF increased by 16 ± 7% in His-CRT vs 13 ± 6% in BiV-CRT (ns) and improvements were seen in clinical and physical parameters in both treatment arms with no significant differences between the groups. Pacing thresholds were higher for His-CRT compared to BiV-CRT both at implantation and at 6-months follow-up.

The per-protocol LVEF was significantly higher at 6 months and the endsystolic volume was lower in His-CRT treated patients compared to BiV-CRT.

Conclusively, In heart failure patients with LBBB, His-CRT provided comparable clinical and physical improvement compared to BiV-CRT at the expense of higher pacing thresholds.

Source: https://www.jacc.org/doi/10.1016/j.jacep.2021.04.003
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