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.