HOT CRT—The Effective Combination of Conventional Cardiac Resynchronization and His Bundle Pacing

Autor: Peter-Stephan Wolff, Anna Winnicka, Adam Ciesielski, Malte Unkell, Grzegorz Zawadzki, Agnieszka Sławuta, Jacek Gajek
Jazyk: angličtina
Rok vydání: 2022
Předmět:
Zdroj: Medicina, Vol 58, Iss 12, p 1828 (2022)
Druh dokumentu: article
ISSN: 1648-9144
1010-660X
DOI: 10.3390/medicina58121828
Popis: Background and Objectives: Cardiac Resynchronization Therapy (CRT) has, besides its benefits, various limitations. For instance, atrial fibrillation (AF) has a huge impact on the therapy efficacy. It usually reduces the overall BiV pacing percentage and leads, inevitably, to lack of fusion beats. In many patients with heart failure that could benefit from resynchronization, the QRS morphology is often IVCD and atypical, or non-LBBB, which further diminishes the CRT response. In those cases, we established His pacing combined with LV pacing as a feasible option to reduce the impact of AF on the CRT response and regain partially physiological ventricular activation to improve the electromechanical sequence. Materials and Methods: We implanted two patients with AF, HF, EF < 35%, NYHA II-III and QRS > 150 ms with CRT-D systems modified to HOT-CRT and observed their clinical, ECG and echocardiographic improvements over a follow-up period of three months. Results: In both patients we observed improvements of the initial parameters. We were able to shorten the QRS duration to approx. 120 ms, improve NYHA functional class, increase the EF by approximately 12% and distinctly reduce mitral regurgitation. Conclusion: Since the conventional CRT reaches its limits within this specific patient group, we need to consider alternative pacing sites and the effective combination of them. Our results and respectively other studies that are also mentioned in the current guidelines, support the feasibility of HOT-CRT in the above mentioned patient group.
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