Praxis der His-Bündel-Stimulation

Konventionelle ventrikuläre Schrittmacherstimulationen sind mit unphysiologischer Erregungsausbreitung im Ventrikelmyokard verbunden. Dies kann zur Ausbildung oder Verschlechterung einer Herzinsuffizienzsymptomatik führen. Die His-Bündel-Stimulation zielt auf die Aktivierung des ventrikulären Reizleitungssystems ab und soll dadurch solche negativen Effekte verhindern.

Kernaussagen

• Die His-Bündel-Stimulation (HBS) ist ein Weg zur „physiologischen“ Stimulation.

• Die HBS ist mit modernen Aggregaten und Elektroden nach Überwinden einer Lernkurve sicher zu etablieren.

• Patienten mit rechtsventrikulärer Stimulationsrate > 20–40% durch AV-Blockierungen oder mit AV-Knotenablation bei therapierefraktärem Vorhofflimmern können profitieren.

• Ebenso können Patienten mit konventioneller Indikation zur kardialen Resynchronisationstherapie profitieren. Die Ergebnisse großer vergleichender Studien gegenüber der biventrikulären Stimulation stehen noch aus.

• Beobachtungsstudien zeigten wiederholt signifikante Verbesserungen bei der Belastbarkeit, der linksventrikulären Ejektionsfraktion und eine geringere Hospitalisierungsrate gegenüber einer rechtsventrikulären Stimulation.

Schlüsselwörter

Schrittmachertherapie - kardiale Resynchronisation - Herzinsuffizienz

Publication History

Article published online:
05 September 2022

• Literatur

• 1 Vijayaraman P, Chung MK, Dandamudi G. et al. His Bundle Pacing. J Am Coll Cardiol 2018; 72: 927-947 DOI: 10.1016/j.jacc.2018.06.017. (PMID: 30115232)
• 2 Kawashima T, Sasaki H. A macroscopic anatomical investigation of atrioventricular bundle locational variation relative to the membranous part of the ventricular septum in elderly human hearts. Surg Radiol Anat 2005; 27: 206-213 DOI: 10.1007/s00276-004-0302-7. (PMID: 15723154)
• 3 James TN, Sherf L. Fine structure of the His bundle. Circulation 1971; 44: 9-28 DOI: 10.1161/01.cir.44.1.9. (PMID: 5561420)
• 4 Lewis AJM, Foley P, Whinnett Z. et al. His Bundle Pacing: A New Strategy for Physiological Ventricular Activation. J Am Heart Assoc 2019; 8: e010972 DOI: 10.1161/jaha.118.010972. (PMID: 30854911)
• 5 Glikson M, Nielsen JC, Kronborg MB. et al. 2021 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy. Eur Heart J 2021; 42: 3427-3520 DOI: 10.1093/eurheartj/ehab364. (PMID: 34455430)
• 6 Vijayaraman P, Dandamudi G, Worsnick S. et al. Acute His-Bundle Injury Current during Permanent His-Bundle Pacing Predicts Excellent Pacing Outcomes. Pacing Clin Electrophysiol 2015; 38: 540-546 DOI: 10.1111/pace.12571. (PMID: 25588497)
• 7 Vijayaraman P, Dandamudi G, Zanon F. et al. Permanent His bundle pacing: Recommendations from a Multicenter His Bundle Pacing Collaborative Working Group for standardization of definitions, implant measurements, and follow-up. Heart Rhythm 2018; 15: 460-468 DOI: 10.1016/j.hrthm.2017.10.039. (PMID: 29107697)
• 8 Zhang S, Zhou X, Gold MR. Left Bundle Branch Pacing: JACC Review Topic of the Week. J Am Coll Cardiol 2019; 74: 3039-3049 DOI: 10.1016/j.jacc.2019.10.039. (PMID: 31865972)
• 9 Nielsen JC, Thomsen PE, Højberg S. et al. A comparison of single-lead atrial pacing with dual-chamber pacing in sick sinus syndrome. Eur Heart J 2011; 32: 686-696 DOI: 10.1093/eurheartj/ehr022. (PMID: 21300730)
• 10 Sweeney MO, Hellkamp AS, Ellenbogen KA. et al. 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 DOI: 10.1161/01.Cir.0000072769.17295.B1.
• 11 Deshmukh P, Casavant DA, Romanyshyn M. et al. Permanent, direct His-bundle pacing: a novel approach to cardiac pacing in patients with normal His-Purkinje activation. Circulation 2000; 101: 869-877 DOI: 10.1161/01.cir.101.8.869. (PMID: 10694526)
• 12 Israel CW, Tribunyan S, Richter S. Indications for His bundle and left bundle branch pacing. Herzschrittmacherther Elektrophysiol 2020; 31: 135-143 DOI: 10.1007/s00399-020-00689-5. (PMID: 32385573)
• 13 Kiehl EL, Makki T, Kumar R. 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: 2272-2278 DOI: 10.1016/j.hrthm.2016.09.027. (PMID: 27855853)
• 14 Upadhyay GA, Vijayaraman P, Nayak HM. et al. On-treatment comparison between corrective His bundle pacing and biventricular pacing for cardiac resynchronization: A secondary analysis of the His-SYNC Pilot Trial. Heart Rhythm 2019; 16: 1797-1807 DOI: 10.1016/j.hrthm.2019.05.009. (PMID: 31096064)
• 15 Sharma PS, Naperkowski A, Bauch TD. et al. Permanent His Bundle Pacing for Cardiac Resynchronization Therapy in Patients With Heart Failure and Right Bundle Branch Block. Circ Arrhythm Electrophysiol 2018; 11: e006613 DOI: 10.1161/circep.118.006613. (PMID: 30354292)
• 16 Vijayaraman P, Naperkowski A, Ellenbogen KA. et al. Electrophysiologic Insights Into Site of Atrioventricular Block: Lessons From Permanent His Bundle Pacing. JACC Clin Electrophysiol 2015; 1: 571-581 DOI: 10.1016/j.jacep.2015.09.012. (PMID: 29759411)
• 17 Hindricks G, Potpara T, Dagres N. et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association of Cardio-Thoracic Surgery (EACTS). Eur Heart J 2021; 42: 373-498 DOI: 10.1093/eurheartj/ehaa612. (PMID: 32860505)
• 18 Brugada J, Katritsis DG, Arbelo E. et al. 2019 ESC Guidelines for the management of patients with supraventricular tachycardiaThe Task Force for the management of patients with supraventricular tachycardia of the European Society of Cardiology (ESC). Eur Heart J 2020; 41: 655-720 DOI: 10.1093/eurheartj/ehz467. (PMID: 31504425)
• 19 Sharma AD, Rizo-Patron C, Hallstrom AP. et al. Percent right ventricular pacing predicts outcomes in the DAVID trial. Heart Rhythm 2005; 2: 830-834 DOI: 10.1016/j.hrthm.2005.05.015. (PMID: 16051118)
• 20 Qi J, Jia X, Wang Z. His bundle pacing for cardiac resynchronization therapy: a systematic literature review and meta-analysis. J Interv Card Electrophysiol 2020; 59: 463-470 DOI: 10.1007/s10840-020-00827-6. (PMID: 32748157)
• 21 Qian Z, Zou F, Wang Y. et al. Permanent His bundle pacing in heart failure patients: A systematic review and meta-analysis. Pacing Clin Electrophysiol 2019; 42: 139-145 DOI: 10.1111/pace.13565. (PMID: 30515877)
• 22 Vijayaraman P, Herweg B, Ellenbogen KA. et al. His-Optimized Cardiac Resynchronization Therapy to Maximize Electrical Resynchronization: A Feasibility Study. Circ Arrhythm Electrophysiol 2019; 12: e006934 DOI: 10.1161/circep.118.006934. (PMID: 30681348)
• 23 Lustgarten DL, Sharma PS, Vijayaraman P. Troubleshooting and programming considerations for His bundle pacing. Heart Rhythm 2019; 16: 654-662 DOI: 10.1016/j.hrthm.2019.02.031. (PMID: 31036247)
• 24 Yu Z, Chen R, Su Y. et al. Integrative and quantitive evaluation of the efficacy of his bundle related pacing in comparison with conventional right ventricular pacing: a meta-analysis. BMC Cardiovasc Disord 2017; 17: 221 DOI: 10.1186/s12872-017-0649-4. (PMID: 28800733)
• 25 Zanon F, Ellenbogen KA, Dandamudi G. et al. Permanent His-bundle pacing: a systematic literature review and meta-analysis. Europace 2018; 20: 1819-1826 DOI: 10.1093/europace/euy058. (PMID: 29701822)
• 26 Slotwiner DJ, Raitt MH, Del-Carpio Munoz F. et al. 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: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Circulation 2019; 140: e483-e503 DOI: 10.1161/cir.0000000000000629.
• 27 Kronborg MB, Mortensen PT, Poulsen SH. et al. His or para-His pacing preserves left ventricular function in atrioventricular block: a double-blind, randomized, crossover study. Europace 2014; 16: 1189-1196 DOI: 10.1093/europace/euu011. (PMID: 24509688)
• 28 Vijayaraman P, Naperkowski A, Subzposh FA. et al. Permanent His-bundle pacing: Long-term lead performance and clinical outcomes. Heart Rhythm 2018; 15: 696-702 DOI: 10.1016/j.hrthm.2017.12.022. (PMID: 29274474)
• 29 Abdelrahman M, Subzposh FA, Beer D. et al. Clinical Outcomes of His Bundle Pacing Compared to Right Ventricular Pacing. J Am Coll Cardiol 2018; 71: 2319-2330 DOI: 10.1016/j.jacc.2018.02.048. (PMID: 29535066)
• 30 Lustgarten DL, Crespo EM, Arkhipova-Jenkins I. et al. His-bundle pacing versus biventricular pacing in cardiac resynchronization therapy patients: A crossover design comparison. Heart Rhythm 2015; 12: 1548-1557 DOI: 10.1016/j.hrthm.2015.03.048. (PMID: 25828601)
• 31 Vijayaraman P, Dandamudi G, Lustgarten D. et al. Permanent His bundle pacing: Electrophysiological and echocardiographic observations from long-term follow-up. Pacing Clin Electrophysiol 2017; 40: 883-891 DOI: 10.1111/pace.13130. (PMID: 28569391)