PHYSIOLOGIC RESYNCHRONIZATION THERAPY (PRT) AFTER A HIS BUNDLE PACING IN A PATIENT WITH A TACHYCARDIOMYOPATHY AND A HEART RATE DEPENDENT LBBB
Background: His bundle pacing is a new method of pacing which showed to be successful in patients with well preserved a-v conduction. Patients with congestive heart failure and LBBB are usually recipients of biventricular CRT pacemakers. This treatment is often successful, but not physiologic. In selected cases resynchronization may be achieved with a His bundle pacing which reverses physiological conduction.
Aim: was to describe the results of the treatment after 54 months of observation
A 65 years old male was qualified for CRT implantation and a-v node ablation due to tachycardiomyopathy and LBBB. He presented, end-stage heart failure refractory for pharmacotherapy. Holter monitoring performed before implantation revealed intermitting LBBB depending on the hart rate. The “Wenckebach point” for the left bundle branch was 90/min, but the mean heart rate was 110/min. His bundle and left ventricle back-up electrode was implanted and a-v node ablation performed, this configuration may be used for a biventricular pacing in case of LBBB progression or loss of HB pacing. After 6 months patient was in the NYHA class I, QRS duration changed from 160 to 100ms, LV diameter and function improved from 65/55mm to 56/39mm EF from 28% to 55%, MVR from 3 to 0 and max VO2 from 6,6 to 24,5 ml/kg/min.
After 54 months of observation patient remained in NYHA class I and the Wenckebach point of the left branch did not change
Conclusion: His bundle pacing may be considered as an optional treatment in patients with tachycardiomyopathy and intermittent, heart rate dependent LBBB.