JAN 20 | NO. 46
IN THIS ISSUE
MESSAGE FROM PRESIDENT
APHRS CABINET 2020
GETTING TO KNOW
Managing Editors: Hsuan-Ming Tsao David Heaven Pipin Kojodjojo Nwe Nwe Seiji Takatsuki Jae-Min Shim Jacky Chan Yuanning Xu Arisara Suwannakul Phan Dinh Phong Aparna Jaswal
APHRS LEADER 06
PHYSIOLOGIC PACING BRIEF UPDATE - HIS BUNDLE PACING
APHRS SUMMIT 2020 MANILA
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MESSAGE FROM PRESIDENT Tachapong Ngarmukos M.D., FAPHRS
We had 175 international speakers, 555 Asia-Pacific speakers, 268 sessions, 27 joint sessions, 3622 attendees from 53 countries and 1197 abstracts submitted. The meeting was organized with the help of the Heart Association of Thailand, under H.M. the King Royal Patronage (HAT). During the 12th APHRS in Bangkok, there were two new events for APHRS, one was the Young EP contest arranged by our Young EP Subcommittee. The other was the first convocation ceremony for the Fellow of APHRS, these fellows were selected by the first President of APHRS and Chair of Nomination Subcommittee, Prof. Hiraoka, recognising those with the outstanding contribution the cause of APHRS.
Dear Colleagues, First, I would like to wish everyone and your family a happy and healthy New Year’s for 2020 and years to come. I am very honored to be elected as the President of the Asia Pacific Heart Rhythm Society for 2020. To be trusted with such an esteemed appointment is afar from my intention nor my imagination when Prof. Teo asked me to help with the Membership Subcommittee over ten years ago. With the presidency, responsibilities, tasks to move APHRS forward into the next decade and to liaise with other local and international societies to achieve the vision of our APHRS were entrusted to me, I will do my best to achieve these goals. I would not have been able to achieve, what I did, without the support of all the Past Presidents, Prof. Masayasu Hiraoka, Prof. Shih-An Chen, Prof. Young-Hoon Kim, Prof. Wee Siong Teo, Prof. Shu Zhang, Prof. Jonathan Kalman, and Prof. ChuPak Lau, who have always been very supportive, kind and trusted me with various assignments, along with enlightening guidance and advice, encouraging and complimenting words. I’m certainly looking forward to the continuation of support, advice and wise words, from all the Past Presidents during my presidency and beyond as always. Other senior members of APHRS, have also been helpful and kind to me to mention a few but not limited to Prof. Yoshinori Kobayashi, Prof. Kazuo Matsumoto, Prof. Muhammad Munarwar, Prof. Mohan Nair, Datuk Omar Razali, and many more of my friends. The 12th APHRS in Bangkok was quite successful.
To achieve the goals of APHRS to promote the excellence and advancement in the study and care of the patients with cardiac rhythm disorders in the Asia-Pacific region, the founders of the society have worked tirelessly to achieve rapid development since 2008. APHRS is now the largest cardiac electrophysiology society in the Asia-Pacific region consist of 971 members from 34 countries, with potential to grow exponentially. Our Asia-Pacific region has 60% of the world population at 4.3 billion people, 48 countries, and with diversity of the people, economy and healthcare systems, it definitely puts APHRS in a position to be very relevant to the advance of sciences and care of cardiac arrhythmia patients in the region. However, advancements in science can be attained in the more established EP members; new discoveries & innovations, original scientific works, and clinical guidelines publications, and conduction of international studies and registries. Our member countries also help educate the physicians from less established areas. We have provided successful new education, scientific exchanges, spreading knowledge during our Annual Scientific Meeting. Prof. Chen has been spearheaded to improve, our society journal, the Journal of Arrhythmia, with progressively better status. APHRS Fellowship supports the young physicians by providing training and experience in advance EP centers in the region and aboard. Collaborating with the Heart Rhythm Society (HRS) and European Heart Rhythm Association (EHRA) is crucial to achieving this goal. Funding from our industry partners help the education process thrive steadily. In addition, Prof. Lau has initiated a separate education funding via a private donation to help education for young physicians who need financial support to attend our Annual Scientific Meeting. For developing areas, the implementation and increase accessibility for the patients to the available treatment modalities will greatly benefit many more cardiac arrhythmia patients in our Asia-Pacific region.
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Prof. Zhang has been working the APHRS White Book since its inception, highlighting the area of opportunity to improve the care of each local area. APHRS summit takes education to the locality where that Annual Scientific Meeting is not held. APHRS also provides practical hands-on courses throughout the year, along with other education courses and educational materials on our website. The Country Matching Program by Prof. Kim has been very successfully executed with advanced EP country to support, train and provide resources to other growing EP society. On the other perspective to increase awareness of disease and treatment options, not just to physicians but directly to the public will increase the chance that we can help preventing morbidity and mortality, relieve suffering of patients with cardiac arrhythmia. Assoc. Prof. Ngai-Yin Chan, Chairman of the Public Affair Subcommittee has been working on AF awareness
APHRS CABINET 2020
campaign, simultaneously in many countries, in the month of September annually, along with AF awareness mobile application in 7 Asian languages. He initiated a sudden cardiac death awareness and education on automated external defibrillator. APHRS collaborated with EHRA to work on a pilot project in Thailand on First Responder mobile application as well. Looking forward to the year 2020, the 13th APHRS will be held in Shanghai on October 29 to November 1, 2020. With Prof. Shu Zhang and Prof. Wei Hua at the helm, this meeting is expected to be even bigger and better. The meeting will be a great opportunity for science, education and networking as always. In this digital age, I am hoping to get our APHRS members to be able to meet, contribute, educate and strongly connect together as the society is moving forward to the future.
BOARD OF TRUSTEES PRESIDENT
Tachapong Ngarmukos, Thailand
1ST VICE PRESIDENT
Wataru Shimizu, Japan
2ND VICE PRESIDENT
Chen-Chuan Cheng, Taiwan
1ST SECRETARY GENERAL
Hui-Nam Pak, Korea
2ND SECRETARY GENERAL
Wei Hua, China
Kyoko Soejima, Japan
SCIENTIFIC PROGRAM CHAIR
Hung-Fat Tse, Hong Kong
CHIEF EDITOR OF THE
Shih-Ann Chen, Taiwan
OFFICIAL JOURNAL NOMINATION COMMITTEE
Masayasu Hiraoka, Japan Shih-Ann Chen, Taiwan Young-Hoon Kim, Korea Wee Siong Teo, Singapore Shu Zhang, China Jonathan Kalman, Australia Chu-Pak Lau, Hong Kong
COUNTRY / REGIONAL REPRESENTATIVES
Yoga Yuniadi, Indonesia
ASIA PACIFIC PRACTICE GUIDELINES
Tze-Fan Chao, Taiwan
Takeshi Aiba, Japan
CARDIAC IMPLANTABLE DEVICES
Giselle Gervacio, Philippines
Dejia Huang | Congxin Huang
Yung-Kuo Lin, Taiwan
Teiichi Yamane, Japan
Chi Keong Ching, Singapore
Chu-Pak Lau, Hong Kong
Akihiko Nogami | Yoshinori Kobayashi
GLOBAL RELATIONS & ENDORSEMENT
Andrew McGavigan, Australia
Martin Stiles, New Zealand
Kok Wei Koh
DOCUMENT WRITING JOINT SESSIONS
Prashanthan Sanders, Australia
Morio Shoda, Japan
Minglong Chen, China
Zahid Aslam Awan
Masayasu Hiraoka, Japan
Ngai-Yin Chan, Hong Kong
Chi Keong Ching
Hung-Fat Tse, Hong Kong
Young-Hoon Kim, Korea
Hsuan-Ming Tsao | Yung-Kuo Lin
Takashi Nitta, Japan
WEB & ARRHYTHMIA NEWS
Anil Saxena, India
Phan Dinh Phong
Kumar Narayanan, India
JAN 20 | NO. 46
GETTING TO KNOW
Tachapong Ngarmukos M.D., FAPHRS Faculty of Medicine Ramathibodi Hospital, Mahidol Univsersity Bangkok Thailand APHRS President (2020) What is the funniest thing that has happened to you recently?
Why did you choose to enter medicine and above all, prefer to specialised in electrophysiology? My mother was a cardiologist, my father is a practicing orthopedist, both were faculties in the Faculty of medicine Chulalongkorn University, so I was quite familiar of the profession. My mother was very good with EKG and I have been enjoy reading EKG since I was a medical student. During my internal medicine residency, I was doing an elective with my mentor, Prof. Nademanee, I saw him ablated atrial flutter to normal sinus rhythm, WOW. That was the beginning.
The recent Papal visit to Bangkok, reminded me of a funny incident. I was a committee in Ramathibodi foundation, when the manager, whom I admired greatly for her work improving the foundation, announced that “Pope” was coming for a Photo shot of a new donation T-shirt campaign. This brought my admiration of her to the new height. Unknowingly that ‘Pope” was a nick name of a young Thai male superstar with a homophones to the holy Pope, I blatantly asked the manager infront of whole committee, including the dean, on how they managed to arrange the papal visit and more amazingly get him to wear the Tshirt for the photo shots, and so secretive that there was no news about the Papal visit. I was met with a long silence followed by the biggest laugh. Thankfully, these was not recorded in the meeting minutes.
What advice would you give to your younger self? Eat less, exercise more & rest well.
Can you talk about an accomplishment that your'e particularly proud of?
If you can get to have a alternative career, what would it be and why?
Organizing the 12th APHRS 2019 Bangkok successfully. I’m not sure wether that was proud or relieved. Another one is that I think, I had trained my EP fellows quite well, or they were just great to begin with.
As a child I knew only a few profession, doctor, pilot and Prime minister! I thought I was going to be a pilot but somehow I got into a medical school, mainly to impress a girl(my wife) and her family, with the exam result!
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What are your hobbies and interests outside of medicine?
Who inspire you the most in your life and why?
Work, work and work! I do not have any activities other than medicine but I do enjoy not doing anything too. I like swimming. I like to build a plastic model, when I have a chance, I have not finished one in a few years.
My parents, they are my heroes, I follow their footsteps, advice and how they live their lives, sound boring! but Iâ€™m enjoying it. They love their children; we are always very important to them. They are kind and generous parents, Iâ€™m one spoiled child. They are friendly and kind to everyone, they are well loved by their colleges, students and patients. My mentor, Prof. Koonlawee Nademanee, world renown yet always friendly and nice to everyone. He told me to always be humble. I think, when my mother was working for the late king Bhumibol, she was influenced by H.M. work ethics; so she repeatedly advised me to do good deed for Thailand and the people. Prof. Nademanee also have a similar point of view. In my opinion, any work that you do that help others will always be rewarding and therefore makes one happier.
What are your thoughts about some of the emerging technologies, and the way they will shape the future care of arrhythmia patients? There will always be breakthrough technologies to help improve our patient care and help shaping how we treat arrhythmia patients, research for new advance treatment for cardiac arrhythmia should always be pursued. I do have an alternative view regarding this issues though, the current established treatment in cardiac arrhythmia can effectively treat almost all patients already, yet in many countries in our region including Thailand, there are still areas that access and availability of these established proven therapy are limited, we need to work on this issues to get the most benefit out of these therapies discovered
What do you regard to be the most significant development in cardiac rhythm management? I think CRT was the major big thing in EP. Mainly it has been very helpful to significant numbers of patients, mortality and morbidity significantly. The other recent development are very useful as well but may be it does not have the similar impact as a CRT.
What is your best life advice, motto or favorite quote? Anything that one does for the good of others will always be rewarding and herefore makes one happier.
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Physiologic pacing brief update - His Bundle Pacing
BY: CHAN KIT, JACKY M.D. Background Right ventricular pacing (RVP) >20-40% is associated with increase risk of heart failure (HF) hospitalization, pacing-induced cardiomyopathy (PICM), atrial fibrillation (AF) and mortality 1-5 . Various physiological pacing techniques including cardiac resynchronization therapy (CRT), His-bundle pacing (HBP) and left-bundle branch pacing (LBBP) have been developed to minimize the adverse cardiovascular (CV) effect of RVP. Among CRT recipients, the non-responder 6 rate remains as high as 30% . Cardiac resynchronizationtherapy has not demonstrated consistent CV benefit in patients with narrow QRS, right bundle branch block7 , or preserved left ventricular 8-9 systolic function (LVSF) . His-bundle pacing (Figure 1) was first reported by Deshmukh et 10 al in 2000. Among patients with chronic AF and dilated cardiomyopathy with narrow QRS complexes, HBP was associated with left ventricular reverse remodeling and improvement of left ventricular ejection fraction (LVEF) from 20±9% to 31±11% (p=0.01). Over the past few years, HBP has evolved into both a stand-alone physiological pacing therapy or as an adjunct to CRT.
Figure 1. His-bundle pacing. (A & B) Fluroscopy in RAO and LAO views showing the position of HBP lead in-situ (arrows) ( Adapted and modified from PS Sharma et al. J Cardiovasc Electrophysiol. 2017. 28(4):458-465.) (C) Diagram showing the His-Purkinje conduction system and the intended target site for HBP lead (arrow). (Adapted and modified from P Vijayaraman et al. J Am Coll Cardiol 2018; 72:927–47). (D) His bundle signal (arrow) recorded by the HBP pacing lead in a patient with AF and high-grade AVB. (E) Baseline H-V interval was 58ms. (F) The pacing stimulus to QRS interval (58ms) was the same as the baseline H-V interval. The HBP paced QRS duration was narrow (65ms). (G) The 12-lead ECG morphology of HBP pacing in the same patient. (H) The echocardiography of the same patient showed preserved left ventricular mechanical synchrony and global longitudinal strain during HBP pacing. Abbreviations: RAO – Right anterior oblique. LAO – Left anterior oblique. HBP – Hisbundle pacing. AF – Atrial fibrillation. AVB – Atrioventricular block.
HBP as an adjunct therapy to CRT In patients with HF and bundle branch block (BBB), HBP with or without LV pacing (LVP) has been shown to improve invasive blood pressure11 . His-optimized CRT (HOT-CRT) improved LVSF and hemodynamic parameters measured by pressure12 conductance volume catheter .
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Among CRT eligible candidates, both HBP and CRT resulted in QRS narrowing, improvement of quality of life (QoL), New York Heart Association (NYHA) functional 13 class, 6-minute hall walk (6MHW) and LVEF . Vijayaraman et al performed HOT-CRT in 27 CRT candidates with a high success rate of 93%. His-optimized CRT resulted in significant QRS narrowing (120±16 ms) compared with baseline (183±27ms) and CRT alone (162±17 ms) (p<0.0001). The LVEF improved from 24±7% to 38±10% (P<0.0001) at 14±10 months follow-up. The clinical response rate (84%) and echocardiographic response rate (92%) was higher compared 14 with conventional CRT . HBP as an alternative therapy to CRT in patients with HF and left bundle branch block (LBBB) Huang et al 15 performed HBP in 74 potential CRT candidates with HF and LBBB. The acute LBBB correction rate was 97.3%. Permanent HBP was successful in 75.7% of patients. Rest of the patients received CRT due to failed LBBB correction, high LBBB correction threshold or failed HBP lead fixation. Among the 56 patients who had successful permanent HBP, 54% completed 3 years follow-up. His-bundle pacing improved LVEF (from 32.4±8.9% to 55.9±10.7% (p<0.001)), left ventricular end-systolic volume (from 137.9±64.1 mL to 52.4±32.6 mL (p<0.001)) and NYHA functional class (from 2.73±0.58 to 1.03±0.18 (p<0.001)). The LBBB acute correction threshold was 2.13±1.19 V @ 0.5 ms and remained stable at 2.29±0.92 V @0.5 ms at 3-years follow-up (p>0.05).
HBP as an upgrade therapy in patients with atrioventricular block (AVB) and/or pacinginduced cardiomyopathy (PICM) Shan et al 16 successfully performed HBP in 16 of 18 patients with pacing-dependent HF and LVEF <50%. About six-nine percent of the patients had PICM while the rest were CRT non-responders. Upgrade to HBP resulted in shortening of QRS duration (from 156.9±21.7
ms to 107.1 ±16.5ms; p<0.01), reduction of left ventricular end-diastolic dimension (from 62.3±6.9mm to 55.5±7.7 mm; p<0.01) and improvement of LVEF (from 35.7%±7.9% to 52.8%±9.6%; p<0.01). Patients also benefited from HBP in terms of mitral regurgitation severity, serum brain natriuretic peptide concentration and NYHA functional class. Vijayaraman et al 17 assessed the effect of HBP in patients with longstanding AVB and chronic RVP and/or pacing-induced cardiomyopathy (PICM) in need for CRT. Hisbundle pacing was successful in 79 of 85 (93%) patients who had received RVP for 77.6±74.8 months. Approximately 30% of AVB patients had infra-nodal block. Hisbundle pacing corrected underlying HisPurkinje conduction disease and shortened QRS duration (from 177±17ms during RVP to 115±20ms during HBP, p<0.001). Pacing threshold was 1.47±0.9V@1ms at implant and 1.9±1.3V@1ms at 25±24 months followup. In the 60 patients with PICM, LVEF improved from 34.3±9.6% to 48.2±9.8% (p<0.001) after HBP.
HBP as a stand-alone therapy in patients with AVB and preserved LVEF In a study of 100 patients with advanced AVB and preserved LVEF, HBP normalized HisPurkinje conduction in 76% of patients with infra-nodal block18 . In a study of 94 pacemaker recipients without HF, HBP significantly reduced heart failure hospitalization (HFH) (2% vs 15% in RVP patients, p=0.02) in those requiring >40% ventricular pacing (in >60% of patients), during a mean follow-up period of 25.5±8.6 months. There was no difference in mortality between HBP and RVP patients19 . Abdelrahman et al 20 performed HBP in 332 consecutive pacemaker recipients. Pacemakers were indicated for sinus node dysfunction and AVB in 35% and 65% of patients respectively. The implant success rate was 92%. The clinical outcome was compared with 443 RVP patients.
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His bundle pacing was associated with a decrease in combined endpoint of death from any cause, HFH or upgrade to biventricular pacing compared with RVP (25% vs 32%; HR 0.71, 95% CI 0.5340.944; p=0.02). The primary outcome was predominantly driven by significant reduction in HFH ((12.4% vs. 17.6%; HR: 0.63; 95% CI: 0.430 to 0.931; p = 0.02). There was no significant difference in mortality between the 2 groups. Patients with >20% ventricular pacing burden benefited most from HBP. Systemic review and meta-analysis of His Bundle Pacing Studies 21
Zanon et al performed the first systemic review and meta-analysis of 1438 patients who received permanent HBP over a period of nearly 20 years, in 16 centers around the world. The average implant success rate was 84.8%. The average LVEF of HBP patients improved from 42.8% at baseline to 49.5% at 16.9 months’ follow-up. Among the 907 patients in the 17 studies which reported safety information, implant complication rate was 4.7%. There were 26 lead revisions due to lead dislodgement (N=6) and elevated threshold (N=20). Early device replacement due to battery depletion was uncommon (0.66%).
HBP was associated with higher LVEF compared with RVP (mean difference 4.33% 95% CI: 0.85-7.81%; p<0.01) at 8.36 months follow-up. However, the HBP did not demonstrate consistent benefit in quality of life and 6MHW distance. Pooled analysis of biventricular pacing and HBP recipients showed that physiologic pacing improved left ventricular reverse remodeling (LVESV and LVEDV reduced by 7.09ml, p=0.0009; I2 =12.98%; and 2.77 mL; p=0.001; I2 = 0% respectively) and LVEF (LVEF improved by 5.328%; 95% CI: 2.86–7.8; p<0.0001; I2 =39.11%) compared with RVP at mean follow-up of 1.64 years. His bundle pacing did not demonstrate consistent benefit over RVP in terms of functional status, quality of life and survival. Patients with LVEF between 36% and 52% were more likely to derive cardiovascular benefit from physiologic pacing. Patients with chronic AF who underwent AVN ablation derived improvement of LVEF from physiologic pacing versus RVP.
Guideline recommendations Latest guideline has given HBP a class IIa recommendation in patients with reduced LV ejection fraction (LVEF) between 36% and 50% who require chronic ventricular pacing 24 .
Qian et al systemically reviewed 11 HBP studies including 494 patients with heart failure. The mean follow-up duration was 23.7 months. In CRT candidates who received HBP, the paced QRS duration was decreased from 165.4±8.7 ms at baseline to 116.9±15.8 ms after HBP (p<0.0001). Left ventricular ejection fraction significantly improved from 36.9±3.3% at baseline to 48.1±3.0% at follow-up (p<0.0001). Left ventricular enddiastolic volume decreased from 58.2 ± 1.7 mm at baseline to 52.8±1.7 mm (p<0.0001). His bundle pacing also improved LVSF in patients with AF who had received trioventricular node (AVN) ablation. 23
Slotwiner et al performed asystemic a review on physiologic pacing versus RVP among patients with LVEF >35%. The review included 679 patients in 8 HBP studies.
Limitations of HBP There are certain limitations for HBP. Firstly, the implant success varies considerably in early studies, ranging from 56% to 95%. The success rate in later studies improved with accumulation of operator experience25-29 . Secondly, HBP patients have higher pacing threshold compared with conventional RVP. Some patients encountered chronic threshold elevation at follow-up. Vijayaraman et al30 reported that His-bundle capture threshold at 5-year follow-up was significantly higher than that in RVP patients (1.62±1.0V vs. 0.84±0.4V at 0.5ms, p<0.05). Moreover, 5year lead revisions rate (6.7%vs3%) and generator replacement rate (9%vs1%) were higher in HBP patients compared with RVP patients.
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Thirdly, the concern of lead instability/ dislodgement often requires an additional backup pacing lead in some patients. The early lead revision rate was higher in HBP patients (4.2% versus 0.5% in RVP) 20. Finally, the progression of infra-hisian His / Purkinje system conduction disease distal to the sight of HBP might result in unpredictable ventricular non-capture at follow-up. The advent of left bundle branch pacing might potentially alleviate some of the above limitations of HBP. Summary His-bundle pacing appears to be a viable stand-alone physiological pacing therapy in pacemaker dependent patients. It could also serve as an effective adjunct or alternative pacing therapy for heart failure patients who require CRT or pacemaker upgrade. Hisbundle pacing has demonstrated improvement of His-Purkinje conduction, left ventricular electrical / mechanical synchronization, and LVEF compared with RVP. Patients who have high pacing dependence and/or LVEF impairment would benefit most from HBP in terms of heart failure hospitalization and LVEF improvement. Mortality benefit has not been consistently demonstrated in latest meta-analysis. The long-term clinical benefit and safety profile of HBP remains to be explored in future studies. References 1. MO Sweeney, AS Hellkamp, KA Ellenbogen et al. MOde Selection Trial Investigators: Adverse effect of ventricular pacing on heart failure and atrial fibrillation among patients with normal baseline QRS duration in a clinical trial of pacemaker therapy for sinus node dysfunction. Circulation. 2003; 107:2932-2937 2. BL Wilkoff, JR Cook, AE Epstein et al: Dual chamber pacing or ventricular backup pacing in patients with an implantable defibrillator: The Dual Chamber and VVI Implantable Defibrillator (DAVID) Trial. JAMA. 2002; 288:3115-123. 3. AD Sharma, C Rizo-Patron, AP Hallstrom et al. Percent right ventricular pacing predicts outcomes in the DAVID trial. Heart Rhythm 2005; 2:830–834.
4. S Khurshid, AE Epstein, RJ Verdino et al. Incidence and predictors of right ventricular pacing-induced cardiomyopathy. Heart Rhythm. 2014;11(9):1619-25. 5. EL Kiehl, T Makki,R Kumar et al. Incidence and predictors of right ventricular pacing induced cardiomyopathy in patients with complete atrioventricular block and preserved left ventricular systolic function. Heart Rhythm 2016;13(12):2272-2278. 6. A Auricchio, FW Prinzen. Non‐responders to cardiac resynchronization therapy. Circulation. 2011;75:521–527. 7. AJ Moss, WJ Hall, DS Cannom, H Klein, MW Brown, JP Daubert, NA Estes, E Foster, H Greenberg, SL Higgins, MA Pfeffer, SD Solomon, D Wilber, W Zareba. Cardiacresynchronization therapy for the prevention of heartfailure events. The New England Journal of Medicine 2009; 361:1329-1338. 9. Curtis AB, Worley SJ, Chung ES, Li P, Christman SA, St John Sutton M: Improvement in Clinical Outcomes With Biventricular Versus Right Ventricular Pacing: The BLOCK HF Study. Journal of the American College of Cardiology 2016; 67:2148-2157. 10. RC Funck, HH Mueller, M Lunati, C Piorkowski, L De Roy, V Paul, M Wittenberg, D Wuensch, JJ Blanc. Characteristics of a large sample of candidates for permanent ventricular pacing included in the Biventricular Pacing for Atrio-ventricular Block to Prevent Cardiac Desynchronization Study (BioPace). Europace 2014; 16:354-362. 11. P Deshmukh, DA Casavant, M Romanyshyn, K Anderson. Permanent, direct Hisbundle pacing: a novel approach to cardiac pacing in patients with normal HisPurkinje activation. Circulation 2000;101:869–877. 12. SMA Sohaib , I Wright , E Lim , P Moore , PB Lim , M Koawing , DC Lefroy , D Lusgarten , NWF Linton , DW Davies , NS Peters , P Kanagaratnam , DP Francis, ZI Whinnett. Atrioventricular Optimized Direct His Bundle Pacing Improves Acute Hemodynamic Function in Patients With Heart Failure and PR Interval Prolongation Without Left Bundle Branch Block. JACC Clin Electrophysiol. 2015. 1(6):582-591. 13. L Pieragnoli, G Ricciardi, L Innocenti, L Checchi, M Padeletti, A Michelucci, F Picariello, S Valsecchi. Simultaneous His Bundle and Left Ventricular Pacing for Optimal Cardiac Resynchronization Therapy Delivery: Acute Hemodynamic Assessment by Pressure-Volume Loops. Circ Arrhythm Electrophysiol 2016 May;9(5). pii: e003793. doi: 10.1161/CIRCEP.115.003793. 14. DL Lustgarten, EM Crespo, IA Jenkins, R Lobel, J Winget, J Koehler, E Liberman, T Sheldon. His-bundle pacing versus biventricular pacing in cardiac resynchronization therapy patients: A crossover design comparison. Heart Rhythm 2015;12:1548-1557. 15. P Vijayaraman, B Herweg, KA Ellenbogen, J Gajek. HisOptimized Cardiac Resynchronization Therapy to Maximize Electrical Resynchronization. A Feasibility Study . Circ Arrhythm Electrophysiol. 2019 Feb;12(2):e006934. doi: 10.1161/CIRCEP.118.006934.
16. W Huang, L Su, S Wu, L Xu, F Xiao, X Zhou, G Mao, P Vijayaraman, KA Ellenbogen. Long-term outcomes of His bundle pacing in patients with heart failure with left bundle branch block. Heart 2019;105:137-143. 17. P Shan, L Su, X Zhou, S Wu, L Xu, F Xiao, X Zhou, KA Ellenbogen, W Huang. Beneficial effects of upgrading to His bundle pacing in chronically paced patients with left ventricular ejection fraction <50%. P Shan, L Su, X Zhou, S Wu, L Xu, F Xiao, X Zhou, KA. Ellenbogen, W Huang. Heart Rhythm. 2018; 15(3), 405–412. 18. P Vijayaraman, B Herweg, G Dandamudi, S Mittal, AG Bhatt, L Marcantoni, A Naperkowski, PS Sharma, F Zanon. Outcomes Of His Bundle Pacing Upgrade After Long-term Right Ventricular Pacing And / Or Pacing-Induced Cardiomyopathy: Insights Into Disease Progression. Heart Rhythm. 2019;16(10):1554-1561. 19. PS Sharma,, G Dandamudi, A Naperkowski, JW Oren,RH Storm,KA Ellenbogen, P Vijayaraman. Permanent His-bundle pacing is feasible, safe, and superior to right ventricular pacing in routine clinical practice. Heart Rhythm 2015;12:305–312 20. M Abdelrahman, FA Subzposh, D Beer, B Durr, A Naperkowski, H Sun, JW Oren, G Dandamudi, P Vijayaraman. Clinical Outcomes of His Bundle Pacing Compared to Right Ventricular Pacing J Am Coll Cardiol 2018. 22;71(20):2319-2330 21. F Zanon, KA Ellenbogen, G Dandamudi, PS Sharma, W Huang, DL Lustgarten, R Tung, H Tada, JN Koneru, T Bergemann, DH Fagan, JH Hudnall, P Vijayaraman. Permanent His-bundle pacing: a systematic literature review andmeta-analysis. Europace. 2018. 1;20(11):1819-1826. 22. Z Qian, F Zou, Y Wang, Y Qiu, X Chen, H Jiang, X Hou. Permanent His bundle pacing in heart failure patients: A systematic review and meta-analysis. Pacing Clin Electrophysiol. 2019;42(2): 139-145. 23. DJ. Slotwiner, MH. Raitt, FDC Munoz, SK. Mulpuru, N Nasser and PN. Peterson. Impact of Physiologic Pacing Versus Right Ventricular Pacing Among Patients With Left Ventricular Ejection Fraction Greater Than 35%. A Systematic Review for the 2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay. Circulation. 2019 Aug 20;140(8):e483-e503. doi: 10.1161/CIR.0000000000000629.
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24. Kusumoto FM, Schoenfeld MH, Barrett C, Edgerton JR, Ellenbogen KA, Gold MR, Goldschlager NF, et al. 2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines, and the Heart Rhythm Society. Circulation.2019Aug20;140(8):e333-e381.doi:10.1161/ CIR.000000000000 0627. 25. Barba-Pichardo R, Manovel Sanchez A, Fernandez-Gomez JM, Morina-Vazquez P, Venegas-Gamero J, Herrera-Carranza M. Ventricular resynchronization therapy by direct His-bundle pacing using an internal cardioverter defibrillator. Europace 2013;15:83–88. 26. Lustgarten DL, Crespo EM, Arkhipova-Jenkins I, et al. Hisbundle pacing versus biventricular pacing in cardiac resynchronization therapy patients: a crossover design comparison. Heart Rhythm 2015;12:1548–1557. 27. Ajijola OA, Upadhyay GA, Macias C, Shivkumar K, Tung R. Permanent Hisbundle pacing for cardiac resynchronization therapy: initial feasibility study in lieu of left ventricular lead. Heart Rhythm 2017;14:1353–1361. 28. Vijayaraman P, Naperkowski A, Ellenbogen KA, Dandamudi G. Electrophysiologic insights into site of atrioventricular block: lessons from permanent His bundle pacing. JACC Clin Electrophysiol 2015;1:571–581. 29. Occhetta E, Bortnik M, Magnani A, et al. Prevention of ventricular desynchronization by permanent para-Hisian pacing after atrioventricular node ablation in chronic atrial fibrillation: a crossover, blinded, randomized study versus apical right ventricular pacing. J Am Coll Cardiol 2006; 47:1938–1945. 30. Vijayaraman P, Naperkowski A, Subzposh FA, Abdelrahman M, Sharma PS, Oren JW et al. Permanent His-bundle pacing: longterm lead performance and clinical outcomes. Heart Rhythm 2018;15:696–702.
APHRS News No. 46 - January 2020