His-Purkinje System Pacing Upgrade Improve the Heart Performances in
Patients Suffering from Pacing-induced Cardiomyopathy with or without
Permanent Atrial Fibrillation
Abstract
The efficacy and safety of His bundle pacing (HBP) and left bundle
branch pacing (LBBP) upgrades in patients with pacing-induced
cardiomyopathy (PICM) and atrial fibrillation (AF) are still unknown.
Methods and results Patients with PICM were continuous enrolled from
January 2018 to March 2020. All patients were further divided into AF
subgroup and sinus rhythm subgroup. Clinical data including
echocardiographic examination parameters, electrocardiogram (ECG)
measurements, and New York Heart Association (NYHA) classification, were
assessed before and after a his-purkinje system pacing (HPSP) upgrade.
The HBP and LBBP upgrades were completed in 34 of 36 (94%),
Complications including electrode dislodged, perforation, infection or
thrombosis were not observed in perioperative period. During a mean of
11.52±5.40 months of follow-up. The left ventricular ejection fraction
(LVEF) increased significantly (33.76±7.54 vs 40.41±9.06,
P<0.001), and the QRS duration decreased (184.22±23.76ms vs
120.52±16.67ms, P<0.001) after the HBP upgrades. LVEDD
reversed from 59.29±7.74 mm to 53.91±5.92 mm (P<0.001), and
the NYHA functional class also improved to 2.00±0.76 from 2.55±0.91 at
the first follow-up (P<0.001). The left atrium (LA) size also
slightly decreased compared to the initial state (59.29±7.74mm VS
56.44±6.46, P=0.005). The threshold o did not increase significantly
(1.18±0.76
[email protected] vs 1.26±0.91mv @ 0.4ms, P=0.581). These improvements
in patients with AF were similar with those in patients without AF (P
>0.05). Conclusion HBP and LBBP upgrades improved the heart
performance and reversed the left ventricular remodeling in patients
suffering from PICM with or without AF, and it should be a promising
choice in these patients.