News | Cardiac Resynchronization Therapy Devices (CRT) | May 15, 2019| Dave Fornell, Editor

His Corrective Pacing Effective as an Initial Strategy for Heart Failure Cardiac Resynchronization

His pacing vs. biventricular pacing in CRT reduced QRS duration 

His Corrective Pacing Effective as an Initial Strategy for Heart Failure Cardiac Resynchronization CRT therapy vs. biventricular pacing (BiV) as a first-line strategy. #HRS #HRS19 #HRS2019

May 15, 2019 — A pilot trial has shown His pacing in cardiac resynchronization therapy (CRT) has been shown to circumvent proximal left bundle branch block (LBBB) and restore electrical resynchronization in patients with heart failure. Results from the study were presented during a late-breaking session at Heart Rhythm 2019, the Heart Rhythm Society's 40th Annual Scientific Sessions.

The HIS SYNC Trial compare His pacing versus biventricular pacing (BiV) as a first-line strategy for CRT in heart failure patients and it was found to be an effective initial strategy with a significant reduction in QRS duration. There was improvement in ejection fraction (EF) with His-CRT greater than with BiV, but the difference was not statistically significant in this pilot study with high crossover rates. Larger prospective studies are justifiable to test for a smaller difference in effect size between CRT modalities.

The HIS SYNC trial was a prospective, multicenter, single-blinded, randomized, controlled pilot trial with 1:1 allocation to His-CRT versus BiV. Patients with standard indications for CRT were enrolled at seven centers. Crossovers were permitted if QRS correction could not be achieved with His CRT or if coronary venous anatomy was unfavorable. The primary endpoints were improvement in QRS duration, LVEF, and freedom from cardiovascular hospitalization or mortality. Echocardiographic response was defined as a >5 percent improvement in left ventricular ejection fraction (LVEF).

The study enrolled 41 patients over a two-year period (one withdrawal, one lost to follow-up). It included 21 patients randomized to His-CRT and 19 to BiV. No differences in baseline characteristics were observed between groups. The median age was 67.5 yrs (54-75.5 yrs), 38% female, and 45% had NICM, with median LVEF of 28% (24-31%) and median QRS duration of 167 ms (155-180 ms) (88% LBBB). The rate of crossover was 48% in the His-CRT arm and 26% in the BiV arm. By intention to treat analysis, a significant reduction in QRS duration was observed with His-CRT (median 167 ms to 140 ms; p=0.001), but not with BiV (162 ms to 153 ms; p=0.13). The median improvement in EF was 9.1% (3.8-14.4%) with His-CRT vs. 5.2% (1.5-11.3%) with BiV (p=0.33) at 6 months, with higher rates of echocardiographic response (67% vs 53%, p=0.40). No differences were seen in freedom from cardiovascular hospitalization (n=5) and mortality (n=1) with low event rates.

All the HRS 2019 late-breaking studies 

Link to other HRS 2019 news

 

Related Content:

ENHANCE CRT Pilot Study Evaluates Alternative Approach for Non-Left Bundle Branch Block Patients

Use of the Interventional CRT Approach to Solve Issues With LV Lead Placement

VIDEO: CRT Optimization Using Echo — Interview with Leyla Elif Sade, M.D.

 

Related Content

Biotronik Launches Acticor DX and CRT-DX Devices in U.S.
News | Cardiac Resynchronization Therapy Devices (CRT) | April 29, 2019
Biotronik announced the full commercial launch of the Acticor device family, including Acticor DX and CRT-DX devices....
Biotronik Launches Acticor and Rivacor ICD and CRT-D Devices in Europe
News | Cardiac Resynchronization Therapy Devices (CRT) | April 18, 2019
Biotronik announced the European market release of what it calls the world’s smallest implantable cardioverter...
Medtronic AdaptivCRT Feature Associated with Improved Heart Failure Patient Survival
News | Cardiac Resynchronization Therapy Devices (CRT) | May 22, 2018
Medtronic plc announced study results showing its AdaptivCRT algorithm is associated with improved patient survival....
Medtronic Recalls CRT-Ds and ICDs Due to Manufacturing Error Preventing Electrical Shock Delivery
News | Cardiac Resynchronization Therapy Devices (CRT) | February 26, 2018
The U.S. Food and Drug Administration (FDA) announced that Medtronic is recalling certain implantable cardioverter...
Abbott Announces MR-Conditional Labeling for Quadra Assura CRT-D and Fortify Assura ICD
Technology | Cardiac Resynchronization Therapy Devices (CRT) | January 03, 2018
Abbott announced U.S. Food and Drug Administration (FDA) approval for magnetic resonance (MR)-conditional labeling for...
Biotronik Announces U.S. Launch of Edora HF-T QP CRT Pacemaker
Technology | Cardiac Resynchronization Therapy Devices (CRT) | August 21, 2017
Biotronik announced U.S. Food and Drug Administration (FDA) approval and commercial availability of Edora HF-T QP, an...
Biotronik Launches DX Technology for U.S. Heart Failure Patients
News | Cardiac Resynchronization Therapy Devices (CRT) | July 21, 2017
Biotronik announced U.S. Food and Drug Administration (FDA) approval and availability of the Intica DX and Intica...
Videos | Cardiac Resynchronization Therapy Devices (CRT) | May 23, 2017
This video, provided by ERB, demonstrates the function and implantation of the WiSE CRT (Wireless Stimulation Endocar
Overlay Init