| Title |
Atrioventricular Optimized Direct His Bundle Pacing Improves Acute Hemodynamic Function in Patients With Heart Failure and PR Interval Prolongation Without Left Bundle Branch Block
|
|---|---|
| Published in |
JACC: Clinical Electrophysiology, October 2015
|
| DOI | 10.1016/j.jacep.2015.08.008 |
| Pubmed ID | |
| Authors |
S.M. Afzal Sohaib, Ian Wright, Elaine Lim, Philip Moore, P. Boon Lim, Michael Koawing, David C. Lefroy, Daniel Lusgarten, Nick W.F. Linton, D. Wyn Davies, Nicholas S. Peters, Prapa Kanagaratnam, Darrel P. Francis, Zachary I. Whinnett |
| Abstract |
The purpose of this study was to investigate whether heart failure patients with narrow QRS duration (or right bundle branch block) but with long PR interval gain acute hemodynamic benefit from atrioventricular (AV) optimization. We tested this with biventricular pacing and (to deliver pure AV shortening) direct His bundle pacing. Benefits of pacing for heart failure have previously been indicated by acute hemodynamic studies and verified in outcome studies. A new target for pacing in heart failure may be PR interval prolongation, which is associated with 58% higher mortality regardless of QRS duration. We enrolled 16 consecutive patients with systolic heart failure, PR interval prolongation (mean, 254 ± 62 ms) and narrow QRS duration (n = 13; mean QRS duration: 119 ± 17 ms) or right bundle branch block (n = 3; mean, QRS duration: 156 ± 18 ms). We successfully delivered temporary direct His bundle pacing in 14 patients and temporary biventricular pacing in 14 participants. We performed AV optimization using invasive systolic blood pressure obtaining parabolic responses (mean R2: 0.90 for His, and 0.85 for biventricular pacing). The mean increment in systolic BP compared with intrinsic ventricular conduction was 4.1 mm Hg (95% confidence interval [CI]: +1.9 to +6.2 mm Hg for His and 4.3 mm Hg [95% CI: +2.0 to +6.5 mm Hg] for biventricular pacing. QRS duration lengthened with biventricular pacing (change = +22 ms [95% CI: +18 to +25 ms]) but not with His pacing (change = +0.5 ms [95% CI: -2.6 to +3.6 ms). AV-optimized pacing improves acute hemodynamic function in patients with heart failure and long PR interval without left bundle branch block. That it can be achieved by single-site His pacing shows that its mechanism is AV shortening. The improvement is ∼60% of the effect size previously reported for biventricular pacing in left bundle branch block. Randomized, blinded trials are warranted to test for long-term beneficial effects. |
X Demographics
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Geographical breakdown
| Country | Count | As % |
|---|---|---|
| United States | 14 | 37% |
| United Kingdom | 9 | 24% |
| Australia | 3 | 8% |
| Philippines | 2 | 5% |
| Netherlands | 1 | 3% |
| Venezuela, Bolivarian Republic of | 1 | 3% |
| Georgia | 1 | 3% |
| Saudi Arabia | 1 | 3% |
| India | 1 | 3% |
| Other | 0 | 0% |
| Unknown | 5 | 13% |
Demographic breakdown
| Type | Count | As % |
|---|---|---|
| Members of the public | 22 | 58% |
| Practitioners (doctors, other healthcare professionals) | 9 | 24% |
| Scientists | 6 | 16% |
| Science communicators (journalists, bloggers, editors) | 1 | 3% |
Mendeley readers
The data shown below were compiled from readership statistics for 48 Mendeley readers of this research output. Click here to see the associated Mendeley record.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| United Kingdom | 1 | 2% |
| United States | 1 | 2% |
| Unknown | 46 | 96% |
Demographic breakdown
| Readers by professional status | Count | As % |
|---|---|---|
| Student > Ph. D. Student | 6 | 13% |
| Other | 5 | 10% |
| Researcher | 5 | 10% |
| Student > Postgraduate | 5 | 10% |
| Student > Master | 4 | 8% |
| Other | 9 | 19% |
| Unknown | 14 | 29% |
| Readers by discipline | Count | As % |
|---|---|---|
| Medicine and Dentistry | 31 | 65% |
| Biochemistry, Genetics and Molecular Biology | 1 | 2% |
| Engineering | 1 | 2% |
| Unknown | 15 | 31% |
Attention Score in Context
This research output has an Altmetric Attention Score of 25. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 26 April 2021.
All research outputs
#1,528,159
of 25,411,814 outputs
Outputs from JACC: Clinical Electrophysiology
#339
of 1,556 outputs
Outputs of similar age
#22,243
of 294,870 outputs
Outputs of similar age from JACC: Clinical Electrophysiology
#4
of 30 outputs
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