The Application Of His-purkinje System Pacing In Patients Who Diagnosed As Heart Failure With Left Bundle Branch Block

Objectives:To investigate the application of His-purkinje system pacing(HPSP)which includes His bundle pacing(HBP)and left bundle branch pacing(LBBP)in patients who diagnosed as heart failure(HF)with left bundle branch block(LBBB).Methods:Those patients who had the implanted indication of cardiac resynchronization therapy(CRT)device,diagnosed HF with LBBB(the duration of QRS complex?130ms),left ventricular ejection fraction(LVEF)?35% and whose clinical symptoms still be obvious after treatment with anti-heart failure drugs guided by the guidelines were enrolled in this prospective study from September 2017 to October 2019 in Department of Cardiology,General Hospital of Northern Theater Command.All the patients voluntarily joined this study with informed consents that HBP would be the top priority to correct the LBBB.When the HBP was failure to correct the LBBB,the LBBP would be the secondary selection used for capturing the LBBB.If the LBBP was still unable to capture the LBBB,the biventricular pacing(BVP)would be the last choice to correct the LBBB.By gathering the statistics of the success rate and clinical application rate of HBP and LBBP,parameters of correcting LBBB and recording duration of pacing QRS complex,LVEF,left ventricular end diastolic anterior and posterior diameter(LVEDD),left ventricular end-systolic volume(LVESV),left ventricular end-diastolic volume(LVEDV)about HBP,LBBP and BVP in preoperative and post-operative follow-up time,in order to evaluate the clinical effect of correcting LBBB by HBP and LBBP.Results:56 patients were included in this study.The mean age was(64±10,30-87),male35.Dilated cardiomyopathy was diagnosed in 46 patients,ischemic cardiomyopathhy in10 patients and atrial fibrillation in 7 patients.HBP correcting LBBB were successfully operated in 33 patients,LBBP correcting LBBB in 14 patients.Thus,The total patients of HBP and LBBP correcting LBBB was 47.HPSP include HBP and LBBP.The total success rate of them correcting LBBB was 84%(47/56).In 56 patients,the success rate of HBP correcting LBBBin 36 of 56 patients was 64%(36/56).CRT were performed by HBP in 33 patients after operation,which the clinical application rate was 59%(33/56).In 23 patients not performed CRT by HBP,14 patients be performed CRT by LBBP to correct LBBB successfully after operation,which the success rate of LBBP correcting LBBB was 61%(14/23)and the clinical application rate was 25%(14/56).The remain9 patients performed by BVP.Among the 33 patients successfully operated CRT by HBP,5 Patients that performed selective his bundle pacing and 28 Patients that performed non-selective his bundle pacing.Among the 33 patients finally performed CRT by HBP,the duration of preoperative QRS complex was(174±15)(140-200)ms,LVEDD was(69±8)(52-86)mm,LVEF was(0.30±0.05)(0.19-0.37),LVEDV was(267±90)(125-488)ml and LVESV was(190±70)(89-356)ml.The duration of immediate postoperative pacing QRS complex to correct the LBBB was(86±10)(60-100)ms,significantly shorter than preoperative(P<0.01).In post-operative 12 months follow-up,the duration of pacing QRS complex to correct the LBBB was(84±11)(80-120)ms,the LVESV was(79±35)(28-190),the LVEDV was(153±39)(93-273)ml,which above of parameters significantly shorter than preoperative(P<0.01),the LVEDD was(55±7)(44-71)mm,significantly shorter than preoperative(P<0.01).The LVEF was(0.48±0.10)(0.27-0.69)significantly raiser than preoperative(P<0.01).Among the 33 patients finally performed by HBP,the immediate postoperative HBP threshold of capturing the LBBB was(1.9.±1.1)(0.5-4.5)V/1ms.In post-operative 12 months follow-up,the HBP threshold of capturing the LBBB was(1.8±1.1)(0.5-4)V/1ms.Among the 14 patients finally performed CRT by LBBP,the duration of preoperative QRS complex was(171±15)(140-190)ms,The preoperative LVEDD was(69±9)(56-89)mm,The preoperative LVEF was(0.30±0.04)(0.2-0.36).The preoperative LVESV was(184±70)(102-328)ml and LVEDV was(260±83)(172-442)ml.The duration of immediate postoperative pacing QRS complex to correct the LBBB was(90±13)(80-120)ms,significantly shorter than preoperative(P<0.01).In post-operative 12 months follow-up,the duration of pacing QRS complex to correct the LBBB was(86±16)(80-120)ms,the LVEDD was(59±11)(49-79)mm,which above of parameters significantly shorter than preoperative(P<0.01).The LVEF was(0.43±0.10)(0.32-0.58),significantly raiser than preoperative(P<0.01).the LVESV was(93±37)(31-120),the LVEDV was(163±33)(120-209)ml,which above of parameters significantly shorter than preoperative(P<0.01).Among the 14 patients performed CRT by LBBP,the immediate postoperative threshold of capturing LBBB was(0.6±0.2)(0.5-1.0)V/1ms.In post-operative 12 months follow-up,the LBBP threshold of capturing the LBBB was(0.9±0.9)(0.5-3)V/1ms.During the follow-up of 12 months,one patient was discovered atrial electrode dislocation,one patient had to extract the pacemaker owing to the infection of sac and only 2 patients occurred that HBP was in capable of correcting the LBBB in the immediately postoperative follow-up.The remain patients were all normal.Conclusions:The total success rate of HBP and LBBP was much higher.HBP and LBBP have good feasibility and can obviously improve the the patients?effect of HF and LBBB.