His-purkinje system pacing improves cardiac performances
The chronic RVP might induce inter- and intraventricular dyssynchrony,
which is detrimental to left ventricular function and associated with
heart failure and increased mortality [10]. The incidence of PICM
was relatively high [11]. However, about 30% of patients were no
response to CRT [12]. A series of publications have suggested that
HBP could provide favorable clinical results in patients with CRT
indications [9, 13]. Notably, Sharma et al. indicated that HBP
showed a positive clinical response in CRT nonresponsive patients
[5]. The His-SYNC trial [14] was the first prospective,
randomized to compared the performance of HBP and conventional CRT. The
narrower QRS was observed in HBP group but the improvement of cardiac
function and survival were no different between the CRT group and HBP
group. Consistently with the studies of Vijayaraman and Sung, our
findings also demonstrated the clinical benefits of HBP upgrades in PICM
patients [8, 11]. Furthermore, we also found that the ratio response
to HBP/LBBP upgrade were relatively high (31/34,89.66%) in patients
with PICM. Furthermore, 12 patients meet replacement indicators before
the upgrade procedure, which indicated that HBP is still efficient and
should be a promising choice even in the patients with long-term RVP.