HOT CRT—The Effective Combination of Conventional Cardiac Resynchronization and His Bundle Pacing
<i>Background and Objectives</i>: Cardiac Resynchronization Therapy (CRT) has, besides its benefits, various limitations. For instance, atrial fibrillation (AF) has a huge impact on the therapy efficacy. It usually reduces the overall BiV pacing percentage and leads, inevitably, to lack...
| Main Authors: | , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2022-12-01
|
| Series: | Medicina |
| Subjects: | |
| Online Access: | https://www.mdpi.com/1648-9144/58/12/1828 |
| _version_ | 1827637914346979328 |
|---|---|
| author | Peter-Stephan Wolff Anna Winnicka Adam Ciesielski Malte Unkell Grzegorz Zawadzki Agnieszka Sławuta Jacek Gajek |
| author_facet | Peter-Stephan Wolff Anna Winnicka Adam Ciesielski Malte Unkell Grzegorz Zawadzki Agnieszka Sławuta Jacek Gajek |
| author_sort | Peter-Stephan Wolff |
| collection | DOAJ |
| description | <i>Background and Objectives</i>: Cardiac Resynchronization Therapy (CRT) has, besides its benefits, various limitations. For instance, atrial fibrillation (AF) has a huge impact on the therapy efficacy. It usually reduces the overall BiV pacing percentage and leads, inevitably, to lack of fusion beats. In many patients with heart failure that could benefit from resynchronization, the QRS morphology is often IVCD and atypical, or non-LBBB, which further diminishes the CRT response. In those cases, we established His pacing combined with LV pacing as a feasible option to reduce the impact of AF on the CRT response and regain partially physiological ventricular activation to improve the electromechanical sequence. <i>Materials and Methods</i>: We implanted two patients with AF, HF, EF < 35%, NYHA II-III and QRS > 150 ms with CRT-D systems modified to HOT-CRT and observed their clinical, ECG and echocardiographic improvements over a follow-up period of three months. <i>Results:</i> In both patients we observed improvements of the initial parameters. We were able to shorten the QRS duration to approx. 120 ms, improve NYHA functional class, increase the EF by approximately 12% and distinctly reduce mitral regurgitation. <i>Conclusion:</i> Since the conventional CRT reaches its limits within this specific patient group, we need to consider alternative pacing sites and the effective combination of them. Our results and respectively other studies that are also mentioned in the current guidelines, support the feasibility of HOT-CRT in the above mentioned patient group. |
| first_indexed | 2024-03-09T16:07:34Z |
| format | Article |
| id | doaj.art-b432f253e9b447a497d343aa0069b14d |
| institution | Directory Open Access Journal |
| issn | 1010-660X 1648-9144 |
| language | English |
| last_indexed | 2024-03-09T16:07:34Z |
| publishDate | 2022-12-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Medicina |
| spelling | doaj.art-b432f253e9b447a497d343aa0069b14d2023-11-24T16:33:26ZengMDPI AGMedicina1010-660X1648-91442022-12-015812182810.3390/medicina58121828HOT CRT—The Effective Combination of Conventional Cardiac Resynchronization and His Bundle PacingPeter-Stephan Wolff0Anna Winnicka1Adam Ciesielski2Malte Unkell3Grzegorz Zawadzki4Agnieszka Sławuta5Jacek Gajek6Department of Cardiology, Augusta Hospital Düsseldorf, Academic Teaching Hospital of the University, Faculty of Health, 40472 Düsseldorf, GermanyDepartment of Cardiology, Multidisciplinary Public Hospital, 67-100 Nowa Sól, PolandDepartment of Cardiology, Multidisciplinary Public Hospital, 67-100 Nowa Sól, PolandStudents’ Scientific Association, Department of Emergency Medical Service, Wroclaw Medical University, 51-616 Wroclaw, PolandStudents’ Scientific Association, Department of Emergency Medical Service, Wroclaw Medical University, 51-616 Wroclaw, PolandDepartment of Internal and Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, 50-566 Wroclaw, PolandDepartment of Emergency Medical Service, Wroclaw Medical University, 51-616 Wroclaw, Poland<i>Background and Objectives</i>: Cardiac Resynchronization Therapy (CRT) has, besides its benefits, various limitations. For instance, atrial fibrillation (AF) has a huge impact on the therapy efficacy. It usually reduces the overall BiV pacing percentage and leads, inevitably, to lack of fusion beats. In many patients with heart failure that could benefit from resynchronization, the QRS morphology is often IVCD and atypical, or non-LBBB, which further diminishes the CRT response. In those cases, we established His pacing combined with LV pacing as a feasible option to reduce the impact of AF on the CRT response and regain partially physiological ventricular activation to improve the electromechanical sequence. <i>Materials and Methods</i>: We implanted two patients with AF, HF, EF < 35%, NYHA II-III and QRS > 150 ms with CRT-D systems modified to HOT-CRT and observed their clinical, ECG and echocardiographic improvements over a follow-up period of three months. <i>Results:</i> In both patients we observed improvements of the initial parameters. We were able to shorten the QRS duration to approx. 120 ms, improve NYHA functional class, increase the EF by approximately 12% and distinctly reduce mitral regurgitation. <i>Conclusion:</i> Since the conventional CRT reaches its limits within this specific patient group, we need to consider alternative pacing sites and the effective combination of them. Our results and respectively other studies that are also mentioned in the current guidelines, support the feasibility of HOT-CRT in the above mentioned patient group.https://www.mdpi.com/1648-9144/58/12/1828CRTHis-bundle pacingHOT-CRTAFIVCDNon-LBBB |
| spellingShingle | Peter-Stephan Wolff Anna Winnicka Adam Ciesielski Malte Unkell Grzegorz Zawadzki Agnieszka Sławuta Jacek Gajek HOT CRT—The Effective Combination of Conventional Cardiac Resynchronization and His Bundle Pacing Medicina CRT His-bundle pacing HOT-CRT AF IVCD Non-LBBB |
| title | HOT CRT—The Effective Combination of Conventional Cardiac Resynchronization and His Bundle Pacing |
| title_full | HOT CRT—The Effective Combination of Conventional Cardiac Resynchronization and His Bundle Pacing |
| title_fullStr | HOT CRT—The Effective Combination of Conventional Cardiac Resynchronization and His Bundle Pacing |
| title_full_unstemmed | HOT CRT—The Effective Combination of Conventional Cardiac Resynchronization and His Bundle Pacing |
| title_short | HOT CRT—The Effective Combination of Conventional Cardiac Resynchronization and His Bundle Pacing |
| title_sort | hot crt the effective combination of conventional cardiac resynchronization and his bundle pacing |
| topic | CRT His-bundle pacing HOT-CRT AF IVCD Non-LBBB |
| url | https://www.mdpi.com/1648-9144/58/12/1828 |
| work_keys_str_mv | AT peterstephanwolff hotcrttheeffectivecombinationofconventionalcardiacresynchronizationandhisbundlepacing AT annawinnicka hotcrttheeffectivecombinationofconventionalcardiacresynchronizationandhisbundlepacing AT adamciesielski hotcrttheeffectivecombinationofconventionalcardiacresynchronizationandhisbundlepacing AT malteunkell hotcrttheeffectivecombinationofconventionalcardiacresynchronizationandhisbundlepacing AT grzegorzzawadzki hotcrttheeffectivecombinationofconventionalcardiacresynchronizationandhisbundlepacing AT agnieszkasławuta hotcrttheeffectivecombinationofconventionalcardiacresynchronizationandhisbundlepacing AT jacekgajek hotcrttheeffectivecombinationofconventionalcardiacresynchronizationandhisbundlepacing |