On-treatment comparison between corrective His bundle pacing and biventricular pacing for cardiac resynchronization: A secondary analysis of the His-SYNC Pilot Trial

医学 心脏再同步化治疗 心脏病学 内科学 射血分数 心脏起搏 心力衰竭 捆绑 复合材料 材料科学
作者
Gaurav A. Upadhyay,Pugazhendhi Vijayaraman,Hemal M. Nayak,Nishant Verma,Gopi Dandamudi,Parikshit S. Sharma,Moeen Saleem,John Mandrola,Davide Genovese,Jess W. Oren,Faiz A. Subzposh,Zaid Aziz,Andrew D. Beaser,Dalise Y. Shatz,Stephanie A. Besser,Roberto M. Lang,Richard G. Trohman,Bradley P. Knight,Roderick Tung
出处
期刊:Heart Rhythm [Elsevier BV]
卷期号:16 (12): 1797-1807 被引量:201
标识
DOI:10.1016/j.hrthm.2019.05.009
摘要

BackgroundThe His-SYNC pilot trial was the first randomized comparison between His bundle pacing in lieu of a left ventricular lead for cardiac resynchronization therapy (His-CRT) and biventricular pacing (BiV-CRT), but was limited by high rates of crossover.ObjectiveTo evaluate the results of the His-SYNC pilot trial utilizing treatment-received (TR) and per-protocol (PP) analyses.MethodsThe His-SYNC pilot was a multicenter, prospective, single-blinded, randomized, controlled trial comparing His-CRT vs BiV-CRT in patients meeting standard indications for CRT (eg, NYHA II–IV patients with QRS >120 ms). Crossovers were required based on prespecified criteria. The primary endpoints analyzed included improvement in QRS duration, left ventricular ejection fraction (LVEF), and freedom from cardiovascular (CV) hospitalization and mortality.ResultsAmong 41 patients enrolled (aged 64 ± 13 years, 38% female, LVEF 28%, QRS 168 ± 18 ms), 21 were randomized to His-CRT and 20 to BiV-CRT. Crossover occurred in 48% of His-CRT and 26% of BiV-CRT. The most common reason for crossover from His-CRT was inability to correct QRS owing to nonspecific intraventricular conduction delay (n = 5). Patients treated with His-CRT demonstrated greater QRS narrowing compared to BiV (125 ± 22 ms vs 164 ± 25 ms [TR], P < .001;124 ± 19 ms vs 162 ± 24 ms [PP], P < .001). A trend toward higher echocardiographic response was also observed (80 vs 57% [TR], P = .14; 91% vs 54% [PP], P = .078). No significant differences in CV hospitalization or mortality were observed.ConclusionsPatients receiving His-CRT on-treatment demonstrated superior electrical resynchronization and a trend toward higher echocardiographic response than BiV-CRT. Larger prospective studies may be justifiable with refinements in patient selection and implantation techniques to minimize crossovers. The His-SYNC pilot trial was the first randomized comparison between His bundle pacing in lieu of a left ventricular lead for cardiac resynchronization therapy (His-CRT) and biventricular pacing (BiV-CRT), but was limited by high rates of crossover. To evaluate the results of the His-SYNC pilot trial utilizing treatment-received (TR) and per-protocol (PP) analyses. The His-SYNC pilot was a multicenter, prospective, single-blinded, randomized, controlled trial comparing His-CRT vs BiV-CRT in patients meeting standard indications for CRT (eg, NYHA II–IV patients with QRS >120 ms). Crossovers were required based on prespecified criteria. The primary endpoints analyzed included improvement in QRS duration, left ventricular ejection fraction (LVEF), and freedom from cardiovascular (CV) hospitalization and mortality. Among 41 patients enrolled (aged 64 ± 13 years, 38% female, LVEF 28%, QRS 168 ± 18 ms), 21 were randomized to His-CRT and 20 to BiV-CRT. Crossover occurred in 48% of His-CRT and 26% of BiV-CRT. The most common reason for crossover from His-CRT was inability to correct QRS owing to nonspecific intraventricular conduction delay (n = 5). Patients treated with His-CRT demonstrated greater QRS narrowing compared to BiV (125 ± 22 ms vs 164 ± 25 ms [TR], P < .001;124 ± 19 ms vs 162 ± 24 ms [PP], P < .001). A trend toward higher echocardiographic response was also observed (80 vs 57% [TR], P = .14; 91% vs 54% [PP], P = .078). No significant differences in CV hospitalization or mortality were observed. Patients receiving His-CRT on-treatment demonstrated superior electrical resynchronization and a trend toward higher echocardiographic response than BiV-CRT. Larger prospective studies may be justifiable with refinements in patient selection and implantation techniques to minimize crossovers.
最长约 10秒,即可获得该文献文件

科研通智能强力驱动
Strongly Powered by AbleSci AI
更新
PDF的下载单位、IP信息已删除 (2025-6-4)

科研通是完全免费的文献互助平台,具备全网最快的应助速度,最高的求助完成率。 对每一个文献求助,科研通都将尽心尽力,给求助人一个满意的交代。
实时播报
盘尼西林完成签到 ,获得积分10
1秒前
LOVE0077完成签到,获得积分10
4秒前
zhao完成签到,获得积分10
6秒前
BINBIN完成签到 ,获得积分10
16秒前
ambrose37完成签到 ,获得积分10
18秒前
量子星尘发布了新的文献求助10
24秒前
fufufu123完成签到 ,获得积分10
28秒前
开心的大娘完成签到,获得积分10
28秒前
www完成签到 ,获得积分10
30秒前
末末完成签到 ,获得积分10
40秒前
无为完成签到 ,获得积分10
41秒前
白嫖论文完成签到 ,获得积分10
43秒前
上官若男应助忧伤的步美采纳,获得10
46秒前
科研通AI2S应助科研通管家采纳,获得10
46秒前
49秒前
从心随缘完成签到 ,获得积分10
50秒前
花花发布了新的文献求助10
52秒前
牛奶面包完成签到 ,获得积分10
53秒前
54秒前
岁月如歌完成签到 ,获得积分0
54秒前
57秒前
Li完成签到,获得积分10
59秒前
张琨完成签到 ,获得积分10
59秒前
59秒前
sunnyqqz完成签到,获得积分10
1分钟前
热情的乘风完成签到,获得积分20
1分钟前
1分钟前
霍凡白完成签到,获得积分10
1分钟前
1分钟前
Feng发布了新的文献求助20
1分钟前
怕孤单的若颜完成签到 ,获得积分10
1分钟前
1分钟前
ruochenzu发布了新的文献求助10
1分钟前
zhongu发布了新的文献求助10
1分钟前
阳光彩虹小白马完成签到 ,获得积分10
1分钟前
Feng完成签到,获得积分10
1分钟前
花花完成签到,获得积分10
1分钟前
1分钟前
量子星尘发布了新的文献求助10
1分钟前
杨一完成签到 ,获得积分10
1分钟前
高分求助中
【提示信息,请勿应助】关于scihub 10000
Les Mantodea de Guyane: Insecta, Polyneoptera [The Mantids of French Guiana] 3000
徐淮辽南地区新元古代叠层石及生物地层 3000
The Mother of All Tableaux: Order, Equivalence, and Geometry in the Large-scale Structure of Optimality Theory 3000
Handbook of Industrial Diamonds.Vol2 1100
Global Eyelash Assessment scale (GEA) 1000
Picture Books with Same-sex Parented Families: Unintentional Censorship 550
热门求助领域 (近24小时)
化学 材料科学 医学 生物 工程类 有机化学 生物化学 物理 内科学 纳米技术 计算机科学 化学工程 复合材料 遗传学 基因 物理化学 催化作用 冶金 细胞生物学 免疫学
热门帖子
关注 科研通微信公众号,转发送积分 4038039
求助须知:如何正确求助?哪些是违规求助? 3575756
关于积分的说明 11373782
捐赠科研通 3305574
什么是DOI,文献DOI怎么找? 1819239
邀请新用户注册赠送积分活动 892655
科研通“疑难数据库(出版商)”最低求助积分说明 815022