Application And Therapeutic Effect Of His Purkinje System Pacing In Ventricular Resynchronization In Chronic HFrEF Patients

Objective:To investigate the application and therapeutic effect of His Purkinje system pacing in patients with chronic HFrEF in cardiac resynchronization therapy(CRT),and to discuss the problems encountered during and after CRT implantation.Methods:Retrospectively collected the clinical data of 23 patients with HFrEF from July 2013 to September 2019,who were implanted the CRT-P/D device in shandong province Qianfoshan hospital cardiovascular department,including:patients’ age,gender and the grade of cardiac function,basic diseases,other accompanying diseases(including hypertension,diabetes,coronary heart disease,etc.),period of heart failure,a 12-lead electrocardiogram,heart doppler ultrasound.All patients were followed up at 22.43±15.8 months after surgery,the X-ray exposure time,intraoperative problems and pacing parameters,as well as the 12-lead electrocardiogram,NYHA grading,cardiac doppler ultrasound,readmission for heart failure or arrhythmia,complications and survival status of the patients after surgery were recorded.According to the different placement of left ventricular electrodes implantation,the patients were divided into two groups:His Purkinje system pacing group and biventricular synchronous pacing group.The clinical efficacy of CRT was observed by comparing preoperative,intraoperative and postoperative recording indexes between the two groups,and the influencing factors of CRT reactivity and the problems encountered were discussed.Results:In 23 cases of patients with chronic HFrEF implanted CRT-P/D device,19 cases were male,and 4 cases were female,mean age 62.48±10.93 years,his purkinje system pacing 10 cases,biventricular synchronous pacing 13 cases,1 case pacemakers electrode were removed out for implanted tissue rejection postoperative,2 cases were readmission with heart failure,1 case was died for lung infection,1 case was died for intestinal infection,and 1 case death due to frequent ventricular tachycardia,All the above adverse events occurred in double ventricular synchronous pacing group.After CRT treatment,there were 6 cases of overreaction in the his purkinje system pacing group and 4 cases in the biventricular synchronous pacing group.There was no statistical difference between the two groups in terms of gender,age,underlying disease,course of heart failure,concomitant disease,cardiac function,types of arrhythmias.Preoperative and postoperative QRS duration of His purkinje system pacing group was 157.00±24.98ms vs 114.90±14.49ms,p<0.001;left ventral end-diastolic diameter(LVEDD)was 70.90±9.41mm vs 58.20±10.28mm,p=0.01;and LVEF was 29.90±4.46%vs 44.80±11.10%,p=0.002.Preoperative and postoperative QRS duration of biventricular synchronous pacing group(170.92±30.15ms vs 142.92±34.96ms,p=0.04),left atrial diameter(LAD)(50.30±4.91mm vs 44.15±6.79mm,p=0.01),and LVEF(27.15±3.69%vs 36.62±12.11%,p=0.02)were statistically different in each group.There was no statistical difference in preoperative QRS duration,left ventricular diameter of cardiac ultrasound,left atrium diameter of cardiac ultrasound and LVEF between his purkinje system pacing group with biventricular synchronous pacing group.There was significant statistical difference in postoperative QRS duration(114.901 14.49ms vs 142.92±34.96ms,p=0.02).Postoperative LVEDD was 58.20 ± 10.28mm vs 66.92 ± 11.95mm,p=0.07;and LVEF was 44.80 ± 11.10%vs 36.62 ± 12.11%,p=0.11,there was no statistical difference between the two groups.Compared with the biventricular synchronous pacing group,the operation time(141.90±82.57min vs 226.77±58.74min,p=0.01)in his purkinje system pacing group,showed significant statistical difference,while the operation success rate and pacing parameters showed no statistical difference.In the his purkinje system pacing,left bundle branch pacing group compared with his bundle pacing group,operation time(73.8±39.46 min vs 210±46.77 min,p=0.001),perception(13.4±4.77 mV vs 6.38 ±3.21 mV,p=0.03),showed significant statistical difference,while the threshold value(0.5±0 V vs 1.03 ± 0.47 V,p=0.07),the impedance(596.4±102.38Ωvs491.4±168.13Ω,p=0.27),and the surgical success rate(100%vs 100.00%,p=1)showed no statistical difference.Conclusion:His purkinje system pacing and biventricular synchronous pacing are both effective treatments to improve biventricular resynchronization,cardiac function and reverse ventricular remodeling in patients with HFrEF.His purkinje system shortened the exposure time,had higher success rate,more stable parameters,narrower postoperative QRS time,better response effect and lower incidence of postoperative adverse events.Compared with his bundle pacing,left bundle branch pacing has shorter operation time,more sensitive perception and lower threshold.