There is a growing body of evidence that His-bundle pacing can prevent what your doctor calls “pacing induced cardiomyopathy,” or heart failure.
His-bundle pacing produces naturally choreographed and synchronized contraction of the ventricles. It has been established as “the only pacing mode capable of inducing a physiologically normal ventricular contraction,” per Dr. Barbo-Pichardo, whom we also quote on our front page.
Studies suggest it prevents the predicted “ventricular remodeling,” that leads to incidences of heart failure over time.
Here are two of the examples in recent years. The first is from the Spring of 2017:
For this study and its paper, whose chief author is Pugazhendhi Vijayaraman, MD, FHRS, the abstract is introduced as follows:
Background: Right ventricular pacing (RVP) is associated with heart failure and increased mortality. His bundle pacing (HBP) is a physiological alternative to RVP.
Objective: The aim of our study is to compare the clinical outcomes of permanent HBP to RVP.
Its wrap-up:
Conclusions: All cause mortality and heart failure hospitalization (HFH) were significantly reduced in patients undergoing permanent HBP compared to RVP at 5 year follow-up. The difference in outcomes were primarily in patients with >40% ventricular pacing.
The comparison is shown in the following two curves:
Two years later, an exacting study has been published indicating that His-bundle pacing actually corrects the heart damage caused by right ventricular pacing.
Again by Dr. Vijayaraman, et. al., this new study’s abstract begins:
Background: His-bundle pacing (HBP) is a physiological alternative to right ventricular pacing (RVP). The outcomes of HBP in patients with longstanding atrioventricular block (AVB) and RVP are unknown.
Objective: The purpose of this study was to retrospectively assess the feasibility of HBP in patients with chronic RVP and longstanding AVB and to evaluate its efficacy in reversing the adverse remodeling induced by RVP.
The practitioners findings:
Conclusion: Despite a long duration of AVB [atrioventricular block] and chronic RVP, HBP normalized QRS complexes and T waves with stable thresholds, suggesting that progression of distal conduction disease is uncommon in this population. Electrical and structural changes induced by chronic RVP were consistently reversed with HBP.
In other words, despite a patient’s preceding pacing induced heart failure, His-bundle pacing provides a more natural heartbeat allowing the heart to heal itself.
