Permanent His bundle pacing to replace biventricular pacing for cardiac resynchronization therapy
| Autor: | Benjamin J. Scherlag, Alexa Papaila |
|---|---|
| Rok vydání: | 2017 |
| Předmět: |
Bundle of His
medicine.medical_specialty Heart Ventricles medicine.medical_treatment Bundle-Branch Block Cardiac resynchronization therapy 030204 cardiovascular system & hematology Cardiac Resynchronization Therapy Electrocardiography 03 medical and health sciences QRS complex 0302 clinical medicine Heart Conduction System Internal medicine medicine Humans Prospective Studies cardiovascular diseases 030212 general & internal medicine Ventricular dyssynchrony Heart Failure Bundle branch block Left bundle branch block business.industry Models Cardiovascular Arrhythmias Cardiac General Medicine medicine.disease Treatment Outcome Heart failure Bundle cardiovascular system Cardiology Electrical conduction system of the heart business circulatory and respiratory physiology |
| Zdroj: | Medical Hypotheses. 109:77-79 |
| ISSN: | 0306-9877 |
| DOI: | 10.1016/j.mehy.2017.09.026 |
| Popis: | Cardiac resynchronization therapy (CRT) or biventricular pacing (BIVP) has become a common procedure for the treatment of ventricular dyssynchrony in patients with heart failure, particularly in those with bundle branch block patterns (QRS durations150ms) on the electrocardiogram (ECG). However, a large group of non-responders are made up of patients with dyssynchrony and QRS duration below 130ms. Recent studies have introduced permanent His bundle pacing as another method for achieving normalization of the QRS duration even in a majority of patients with right or left bundle branch block pattern on the ECG.We hypothesize 1. Biventricular pacing, (BIVP) performed as the standard procedure for CRT is inherently abnormal, spatially, at the right and left ventricular apex, and temporally, in regard to the timing of normal activation of the interventricular conduction system. Corollary 1. Permanent, selective, His bundle pacing (PHBP) is the most physiological form of ventricular pacing which replicates the normal activation of the interventricular conduction system. Corollary 2. An appropriately powered, prospective, crossover trial comparing PHBP with BIVP will show that the former is associated with the same benefits in patients with heart failure and QRS durations130ms and would improve, rather than worsen, outcomes in heart failure patients with QRS duration130ms. We present experimental and clinical evidence in support of these hypotheses. |
| Databáze: | OpenAIRE |
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