PMID- 34167929
OWN - NLM
STAT- MEDLINE
DCOM- 20220202
LR  - 20220202
IS  - 2405-5018 (Electronic)
IS  - 2405-500X (Linking)
VI  - 7
IP  - 11
DP  - 2021 Nov
TI  - A Randomized Trial of His Pacing Versus Biventricular Pacing in Symptomatic HF 
      Patients With Left Bundle Branch Block (His-Alternative).
PG  - 1422-1432
LID - S2405-500X(21)00328-5 [pii]
LID - 10.1016/j.jacep.2021.04.003 [doi]
AB  - OBJECTIVES: This study sought to compare 2 ways of achieving cardiac 
      resynchronization. BACKGROUND: Cardiac resynchronization therapy (CRT) in 
      patients with symptomatic heart failure and left bundle branch block (LBBB) can 
      be achieved with His-bundle pacing correcting the bundle branch block (His-CRT). 
      The present study is the largest randomized study comparing His-CRT and 
      biventricular pacing (BiV-CRT) to date. METHODS: Fifty patients with symptomatic 
      heart failure, left ventricular ejection fraction (LVEF) </=35% and LBBB according 
      to electrocardiography were randomized 1:1 to His-CRT or BiV-CRT and followed for 
      6 months. At implantation, 7 patients crossed over from His-pacing to LV-pacing 
      in the His-CRT group and 1 patient crossed over from LV-pacing to His-pacing in 
      the BiV-CRT group. RESULTS: His-corrective pacing was achieved in 72% of the 
      patients in the His-CRT group. Intention-to-treat 6-month follow-up LVEF 
      increased by 16 +/- 7% in the His-CRT group compared with 13 +/- 6% in the BiV-CRT 
      group (nonsignificant) and improvements were seen in clinical and physical 
      parameters in both treatment arms with no significant differences between the 
      groups. Pacing thresholds were higher for His-CRT compared with BiV-CRT both at 
      implantation (1.8 +/- 1.2 V vs. 1.2 +/- 0.8 V; p < 0.01) and at 6-month follow-up 
      (2.3 +/- 1.4 V vs. 1.4 +/- 0.5 V; p < 0.01). The per-protocol LVEF was significantly 
      higher at 6 months (48 +/- 8% vs. 42 +/- 8%; p < 0.05) and the end-systolic volume 
      was lower (65 +/- 22 ml vs. 83 +/- 27 ml; p < 0.05) in His-CRT patients compared with 
      BiV-CRT. CONCLUSIONS: In heart failure patients with LBBB, His-CRT provided 
      similar clinical and physical improvement compared with BiV-CRT at the expense of 
      higher pacing thresholds.
CI  - Copyright (c) 2021 American College of Cardiology Foundation. Published by Elsevier 
      Inc. All rights reserved.
FAU - Vinther, Michael
AU  - Vinther M
AD  - Department of Cardiology, The Heart Center, Copenhagen University 
      Hospital-Rigshospitalet, Copenhagen, Denmark. Electronic address: 
      michael.vinther@regionh.dk.
FAU - Risum, Niels
AU  - Risum N
AD  - Department of Cardiology, The Heart Center, Copenhagen University 
      Hospital-Rigshospitalet, Copenhagen, Denmark.
FAU - Svendsen, Jesper Hastrup
AU  - Svendsen JH
AD  - Department of Cardiology, The Heart Center, Copenhagen University 
      Hospital-Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, 
      Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, 
      Denmark.
FAU - Mogelvang, Rasmus
AU  - Mogelvang R
AD  - Department of Cardiology, The Heart Center, Copenhagen University 
      Hospital-Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, 
      Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, 
      Denmark.
FAU - Philbert, Berit Thornvig
AU  - Philbert BT
AD  - Department of Cardiology, The Heart Center, Copenhagen University 
      Hospital-Rigshospitalet, Copenhagen, Denmark.
LA  - eng
PT  - Journal Article
PT  - Randomized Controlled Trial
PT  - Research Support, Non-U.S. Gov't
DEP - 20210425
PL  - United States
TA  - JACC Clin Electrophysiol
JT  - JACC. Clinical electrophysiology
JID - 101656995
SB  - IM
MH  - Bundle-Branch Block/therapy
MH  - *Cardiac Resynchronization Therapy
MH  - Humans
MH  - Stroke Volume
MH  - Treatment Outcome
MH  - Ventricular Function, Left
OTO - NOTNLM
OT  - His-pacing
OT  - biventricular pacing
OT  - cardiac resynchronization therapy
OT  - heart failure
OT  - left bundle branch block
COIS- Funding Support and Author Disclosures This study was funded by a research grant 
      from the Clinical Research Unit at the Heart Center, Rigshospitalet, Copenhagen, 
      Denmark. The authors have reported that they have no relationships relevant to 
      the contents of this paper to disclose.
EDAT- 2021/06/26 06:00
MHDA- 2022/02/03 06:00
CRDT- 2021/06/25 05:50
PHST- 2021/02/10 00:00 [received]
PHST- 2021/03/29 00:00 [revised]
PHST- 2021/04/07 00:00 [accepted]
PHST- 2021/06/26 06:00 [pubmed]
PHST- 2022/02/03 06:00 [medline]
PHST- 2021/06/25 05:50 [entrez]
AID - S2405-500X(21)00328-5 [pii]
AID - 10.1016/j.jacep.2021.04.003 [doi]
PST - ppublish
SO  - JACC Clin Electrophysiol. 2021 Nov;7(11):1422-1432. doi: 
      10.1016/j.jacep.2021.04.003. Epub 2021 Apr 25.