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Bundle of his pacing

Juanita Hunter, Emmanouil Tsounias, John Cogan, Ming-Lon Young
BACKGROUND Lown-Ganong-Levine syndrome, includes a short PR interval, normal QRS complex, and paroxysmal tachycardia. The pathophysiology of this syndrome includes an accessory pathway connecting the atria and the atrioventricular (AV) node (James fiber), or between the atria and the His bundle (Brechenmacher fiber). Similar features are seen in enhanced atrioventricular nodal conduction (EAVNC), with the underlying pathophysiology due to a fast pathway to the AV node, and with the diagnosis requiring specific electrophysiologic criteria...
March 18, 2018: American Journal of Case Reports
Mohamed Abdelrahman, Faiz A Subzposh, Dominik Beer, Brendan Durr, Angela Naperkowski, Haiyan Sun, Jess W Oren, Gopi Dandamudi, Pugazhendhi Vijayaraman
BACKGROUND: Right ventricular pacing (RVP) is associated with heart failure and increased mortality. His bundle pacing (HBP) is a physiological alternative to RVP. OBJECTIVE: The aim of the study is to evaluate clinical outcomes of HBP compared to RVP. METHODS: All patients requiring initial pacemaker implantation between Oct 1st , 2013 and December 31st , 2016 were included in the study. Permanent HBP was attempted in consecutive patients at one hospital and RVP at a sister hospital...
March 5, 2018: Journal of the American College of Cardiology
Krzysztof Boczar, Agnieszka Sławuta, Andrzej Ząbek, Maciej Dębski, Jacek Gajek, Jacek Lelakowski, Barbara Małecka
CRT is a therapeutic option for patients with heart failure, sinus rhythm, prolonged QRS complex duration and reduced ejection fraction. We present a case of 71-year-old woman with dilated cardiomyopathy, NYHA functional class III and AF. We implanted CRT combined with direct His-bundle pacing. The indication for such a therapy was a left bundle branch block with a QRS complex of 178ms and a left ventricular EF of 15%, left ventricular end-diastolic diameter (LVEDD) of 75mm. After 8months of follow-up the LVEDD was 60mm with EF 35-40%...
March 2, 2018: Journal of Electrocardiology
Neal A Chatterjee, E Kevin Heist
Cardiac resynchronization therapy (CRT) is an important therapeutic tool in the management of patients with heart failure and electrical dyssynchrony. In appropriately selected patients, landmark randomized controlled trials have demonstrated morbidity and mortality benefit beyond standard goal-directed medical therapy. Current guidelines emphasize the greatest clinical efficacy of CRT in patients with symptomatic heart failure, left bundle branch block, and wide QRS duration (> 150 ms). Other relevant considerations include the presence of atrial fibrillation, the presence of AV block, the etiology of cardiomyopathy, the presence of masked left-sided conduction delay, and the impact of comorbidities that might predict poor clinical response...
March 6, 2018: Current Treatment Options in Cardiovascular Medicine
William A Huang, Maereg A Wassie, Olujimi A Ajijola
His bundle pacing (HBP) has been shown to be a feasible, beneficial, and safe way to achieve cardiac resynchronization therapy (CRT) with recruitment of the heart's physiological conduction system. HBP should be considered for those with unfavorable coronary sinus (CS) anatomy, and nonresponders to biventricular (BiV) pacing. HBP CRT may also help patients with the nonleft bundle branch block form of conduction delay and heart failure (HF). HBP CRT should be considered strongly in preventing right ventricular (RV) pacing-induced cardiomyopathy, especially after atrioventricular nodal ablation given the discrete nature of the block and the low likelihood of distal block...
March 6, 2018: Current Treatment Options in Cardiovascular Medicine
Angelo Auricchio, Ward A Heggermont
Cardiac resynchronization therapy (CRT) is a well-established treatment for symptomatic heart failure patients with reduced left ventricular ejection fraction, prolonged QRS duration, and abnormal QRS morphology. The ultimate goals of modern CRT are to improve the proportion of patients responding to CRT and to maximize the response to CRT in patients who do respond. While the rate of CRT nonresponders has moderately but progressively decreased over the last 20 years, mostly in patients with left bundle branch block, in patients without left bundle branch block the response rate is almost unchanged...
February 14, 2018: Revista Española de Cardiología
Krishna Kumar Mohanan Nair, Narayanan Namboodiri, Hiren Kevadiya, Ajitkumar Valaparambil
A 35-year old lady was referred for evaluation of recurrent palpitation. During one of the episodes of palpitation a wide QRS tachycardia with left bundle branch block (LBBB) morphology was recorded and it was terminated with intravenous adenosine. The surface electrocardiogram during sinus rhythm did not show any pre-excitation. Echocardiogram was normal. Patient underwent an electrophysiology study after informed consent. During catheter placement a wide QRS tachycardia with LBBB morphology and left axis deviation (LAD) similar to the clinical tachycardia got induced (Fig:1)...
February 14, 2018: Pacing and Clinical Electrophysiology: PACE
Fatima M Ezzeddine, Gopi Dandamudi
Long-term right ventricular apical pacing has been associated with detrimental effects, including an increased risk for heart failure, atrial fibrillation, and death. Most of these adverse effects result from ventricular dyssynchrony related to perturbed ventricular depolarization. In addition, biventricular pacing has limited benefits in patients with non-left bundle branch block and severely reduced ejection fraction. Consequently, alternative pacing strategies that mimic natural physiology are desired. Recently, permanent His bundle pacing has emerged as a true physiologic form of ventricular pacing that has been shown to be safe and feasible in clinical practice...
March 2018: Cardiac Electrophysiology Clinics
Jose M Marcial, Seth J Worley
Subclavian obstruction is common after lead implantation and the need to add or replace a lead is increasing. Subclavian venoplasty (SV) is a safe and effective option for venous occlusion. Peripheral venography overestimates the severity of the obstruction. A wire can usually be advanced into the central circulation for SV. Compared with dilators, SV improves the quality of venous access, providing unrestricted catheter manipulation for His bundle pacing and left ventricular lead implantation. SV preserves venous access and reduces lead burden...
March 2018: Cardiac Electrophysiology Clinics
Parikshit S Sharma, Kristin Ellison, Hena N Patel, Richard G Trohman
No abstract text is available yet for this article.
November 2017: HeartRhythm Case Reports
Marek Jastrzebski, Piotr Kukla, Danuta Czarnecka
No abstract text is available yet for this article.
January 2018: HeartRhythm Case Reports
Agnieszka Sławuta, Krzysztof Boczar, Andrzej Ząbek, Jacek Gajek, Jacek Lelakowski, Pugazhendhi Vijayaraman, Barbara Małecka
A man with non-ischemic cardiomyopathy, EF 22%, permanent AF and ICD was admitted for elective device replacement. The need for the optimization of the ventricular rate and avoidance of right ventricular pacing made it necessary to up-grade the existing pacing system using direct His bundle pacing and dual chamber ICD. This enabled the regularization of ventricular rate, avoiding the RV pacing and optimize the beta-blocker dose. The one month follow-up already showed reduction in left ventricle diameter, improvement in ejection fraction, NYHA class decrease to II...
January 23, 2018: Polski Merkuriusz Lekarski: Organ Polskiego Towarzystwa Lekarskiego
Pugazhendhi Vijayaraman, Angela Naperkowski, Faiz A Subzposh, Mohamed Abdelrahman, Parikshit S Sharma, Jess W Oren, Gopi Dandamudi, Kenneth A Ellenbogen
BACKGROUND: Right ventricular pacing (RVP) is associated with heart failure and increased mortality. His-bundle pacing (HBP) is a physiological alternative to RVP. OBJECTIVE: The purpose of this study was to report long-term performance and compare the clinical outcomes of permanent HBP vs RVP. METHODS: All patients requiring pacemaker implantation underwent an attempt at permanent HBP in 2011 at one hospital and RVP at the sister hospital...
December 20, 2017: Heart Rhythm: the Official Journal of the Heart Rhythm Society
Pugazhendhi Vijayaraman, Faiz A Subzposh, Angela Naperkowski
Aims: Atrioventricular node ablation (AVNA) and right ventricular pacing (RVP) are effective therapies for patients with atrial fibrillation (AF) and rapid ventricular rates. His bundle pacing (HBP) is a physiologic alternative to RVP. The aim of our study is to assess the feasibility and safety of HBP in patients undergoing AVNA and its effect on left ventricular (LV) function. Methods and results: Permanent HBP is the preferred form of ventricular pacing at our institute...
December 1, 2017: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
Weijian Huang, Lan Su, Shengjie Wu, Lei Xu, Fangyi Xiao, Xiaohong Zhou, Kenneth A Ellenbogen
This report demonstrates the feasibility of pacing the left bundle branch (LBB) immediately beyond the conduction block to functionally restore the impaired His-Purkinje conduction system in a patient with heart failure and left bundle branch block (LBBB). The pacing required only a low pacing output (0.5 volts/0.5 ms) to correct the LBBB with accompanying right BBB on the electrocardiogram. Over 1-year of follow-up, the patient had a significant improvement in clinical outcome and echocardiographic measurements...
December 2017: Canadian Journal of Cardiology
Daniel Lavall, Bruno Scheller, Christian Werner, Axel Buob, Felix Mahfoud
A patient presented with symptoms of decompensated heart failure 2 months after percutaneous mitral valve (MV) repair. Echocardiography demonstrated impaired left ventricular function with elevated MV pressure gradients and pulmonary pressures during rapid atrial fibrillation. Heart rate control was achieved by implantation of a biventricular pacemaker with subsequent His-bundle ablation because atrial fibrillation was refractory to medical treatment. During biventricular pacing at different rates (50-110 b...
November 23, 2017: ESC Heart Failure
Benjamin J Scherlag, Alexa Papaila
INTRODUCTION: 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 durations >150ms) 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...
November 2017: Medical Hypotheses
Pugazhendhi Vijayaraman, Gopi Dandamudi, Francesco Zanon, Parikshit S Sharma, Roderick Tung, Weijian Huang, Jayanthi Koneru, Hiroshi Tada, Kenneth A Ellenbogen, Daniel L Lustgarten
His bundle pacing (HBP) prevents ventricular dyssynchrony and its long-term consequences by preserving normal electrical activation of the ventricles. Since the original description of permanent HBP in 2000, the adoption of HBP has increased over the past several years. However, the reporting of procedural and clinical outcomes to date is not uniform. This article is a collaboration between several implanters with significant experience in HBP to establish a uniform set of definitions encompassing the different forms of HBP as well as define a standardized approach to gathering data end points to ensure consistency in reported outcomes...
March 2018: Heart Rhythm: the Official Journal of the Heart Rhythm Society
Ron Sela, Mark Gellerman, Shaul Atar, Eli Kalfon
No abstract text is available yet for this article.
October 2017: Israel Medical Association Journal: IMAJ
Peiren Shan, Lan Su, Xiaodong Zhou, Shengjie Wu, Lei Xu, Fangyi Xiao, Xiaohong Zhou, Kenneth A Ellenbogen, Weijian Huang
BACKGROUND: Heart failure is common in patients with permanent pacemakers. Right ventricular (RV) pacing may worsen cardiac function, while the nonresponder rate of cardiac resynchronization therapy (CRT) for heart failure treatment remains 25%-30%. OBJECTIVE: The purpose of this study was to assess clinical outcomes of upgrading to permanent His bundle pacing (pHBP) in patients with heart failure who underwent device upgrade from right ventricular pacing or CRT nonresponse...
November 16, 2017: Heart Rhythm: the Official Journal of the Heart Rhythm Society
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