His-purkinje system pacing upgrade improve the heart performances in patients suffering from pacing-induced cardiomyopathy with or without permanent atrial fibrillation

• Published in: International journal of cardiology Vol. 335; pp. 47 - 51
• Main Authors: Yang, Yi-heng, Wang, Ke-xin, Ma, Pei-pei, Zhang, Rong-feng, Waleed, Khalid Bin, Yin, Xiaomeng, Gao, Lian-jun, Xia, Yun-long, Dong, Ying-xue
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 15.07.2021
• Subjects: Cardiac function; His-Purkinje system pacing; Pacing-induced cardiomyopathy; His-Purkinje system pacing; Pacing-induced cardiomyopathy; Cardiac function
• ISSN: 0167-5273; 1874-1754
• DOI: 10.1016/j.ijcard.2021.04.012

The efficacy and safety of his-purkinje system pacing (HPSP) upgrades in patients with pacing-induced cardiomyopathy (PICM) and atrial fibrillation (AF) are still unknown. Patients with PICM were continuously 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 the procedure. The HPSP upgrades, including his bundle pacing (HBP) and left bundle branch pacing (LBBP) were completed in 34 of 36 (94%) patients, Complications including electrode dislodged, perforation, infection or thrombosis were not observed in the 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 ± 23.76 ms vs 120.52 ± 16.67 ms, P < 0.001) after the 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 (47.44 ± 7.14 mm VS 45.56 ± 7.78, P = 0.010). BNP significantly decreased from a median value of 458.06(256.35–755.10) to 172.31(92.69–552.14) (P = 0.004). The threshold did not increase significantly (1.18 ± 0.76 mv@0.4 ms vs 1.26 ± 0.91mv @ 0.4 ms, P = 0.581). These improvements in patients with AF were similar with those in patients without AF (P > 0.05). HPSP 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. •His-purkinje system pacing upgrade could remain its efficacy in patients with picm even though after long-term right ventricualr pacing.•No matter whether accompany with atrial fibrillation, PICM patients could definitely benefit from His-purkinje system pacing upgrade.•The distal His-purkinje system pacing could provided favorable sensed R wave, stable capture threshold during our follow up period, even after long-term right ventricular pacing.