Presented at Cleveland Clinic Florida Tall Rounds, April 2019

1. His bundle pacing as
resynchronization therapy
Physiology, Early Results, Ongoing Research
Sergio L. Pinski, MD
Cleveland Clinic Florida
@SergioPinski

3. Narula OS. Circulation 1977;56;996
20 out of 80 patients with LBBB normalized QRS with distal His pacing

4. Ajijola et al. Heart Rhythm 2017;14:1353

5. @SergioPinski

6. @SergioPinski

7. Lustgarten et al. Heart Rhythm 2015;12:1548

8. NS-HBP with LBBB
correction
NS-HBP without LBBB
correction
S-HBP without
LBBB correction
NSR with
LBBB
@SergioPinski

9. Ali et al. Arrhythm Electrophysiol Rev 2018;7:103

10. Upadhyay et al. Circulation 2019;139:1876

11. Strauss et al. Am J Cardiol 2011;107:927

12. Upadhyay & Tung. J Cardiovasc Electrophysiol 2019; (in press)

13. His resynchronization versus biventricular pacing in pts
with CHF and LBBB
Arnold et al. JACC 2018:72:3112

14. His-bundle pacing versus biventricular pacing in
CRT patients: A crossover design comparison
Lustgarten et al. Heart Rhythm 2015:12:1548

15. Sharma et al. Heart Rhythm 2018; 15:413

16. Long Term Outcomes of His Bundle Pacing in Patients
with Heart Failure and Left Bundle Branch Block
Huang et al. Heart 2019;105;137

17. Qian et al. PACE 2019; 42:139

18. His Bundle Pacing vs Coranry Sinus Pacing
for Cardiac Resynchronization Therapy Trial
(His-SYNC)
• Randomized multicenter single blind trial in the US
• 40 patients with CHF and current indication for CRT
• His bundle pacing versus coronary sinus pacing
• Primary endpoints: changes in LVEF, time to first CV admission or
death
• Secondary endpoints: NYHA functional class, QOL, time to
arrhythmia treatment

19. His-Optimized Cardiac Resynchronization Therapy (HOT-CRT)
Vijayaraman et al. Circ Arrh Electrophysiol 2019;12:e006934

20. @SergioPinski
His-Optimized Cardiac Resynchronization Therapy (HOT-CRT)

23. @UwaisMohamed8
LBBB Pacing (Huang Technique)

24. @Gauravaupadhyay

25. Normalization of RBBB

26. CRT does not benefit patients with RBBB – MADIT-CRT
Zareba et al. Circulation 2011;123:1061

28. Permanent His Bundle Pacing for CRT in
patients with Heart Failure and RBBB
Sharma et al. Circ Arrhyhm Electrophysiol 2018;11:e006613

29. Permanent His Bundle Pacing for CRT in patients
with Heart Failure and RBBB
Sharma et al. Circ Arrhyhm Electrophysiol 2018;11:e006613

32. • 17 pts in sinus rhythm,
systolic heart failure, PR >
200 ms, and either QRS <140
ms or RBBB
AV Optimized Direct His-Bundle Pacing Improves Acute
Hemodynamic Function in Patients With HF and PR Interval
Prolongation Without LBBB
Sohaib et al. JACC Clin Electrophysiol 2015;1:582

33. His Optimized Pacing Evaluated for
Heart Failure (HOPE-HF) Trial
• Randomized multicenter trial in the UK
• 160 patients with LVEF <40%, PR > 200 ms, narrow QRS or RBBB
• His bundle pacings versus no stimulation
• Primary endpoint: metabolic stress test with VO2 max
• Secondary endpoints: changes in LVEF, BNP, QOL, daily activities;
feasibility and complications
Keene et al. ESC Heart Fail 2018; (in press)

34. La estimulación del Haz de His preserva la
sincronía AV, interventricular e intraventricular
Ali et al. Arrhythm Electrophysiol Rev 2018;7:103

36. Bunting et al. PACE 2017;40:35

37. @SergioPinski

38. Anterior vein Posterolateral vein
@SergioPinski

39. @SergioPinski

40. @SergioPinski

42. Kroon et al. Heart Rhythm 2015;12:1259@SergioPinski #HFSA2017