Effects of haemodynamically atrio-ventricular optimized His-pacing on heart failure symptoms and exercise capacity: The His Optimized Pacing Evaluated for Heart Failure (HOPE-HF) randomised, double-blind, cross-over trial

Abstract

Aims: Excessive prolongation of PR interval impairs coupling of AV contraction, which reduces left ventricular pre-load and stroke volume, and worsens symptoms. His-bundle pacing allows AV-delay shortening while maintaining normal ventricular activation. HOPE-HF evaluated whether AV-optimized His pacing is preferable to no-pacing, in double-blind cross-over fashion, in patients with heart failure, left ventricular ejection fraction (LVEF) ≤40%, PR interval ≥200ms and either QRS ≤140ms or right BBB. Methods and results: Patients had atrial and His-bundle leads implanted (and an ICD lead if clinically indicated) and were randomized, to 6-months of pacing and 6-months of no-pacing utilizing a cross-over design. The primary outcome was peak oxygen uptake during symptom-limited exercise. Quality of life, LVEF and patients' holistic symptomatic preference between arms were secondary outcomes. 167 patients were randomized: 90% men, 69±10 years, QRS duration 124±26ms, PR interval 249±59ms, LVEF 33±9%. Neither peak VO2 (+0.25 ml/min/kg, 95% CI -0.23 to +0.73, p=0.3) nor LVEF (+0.5%, 95% CI -0.7 to 1.6, p=0.4) changed with pacing but Minnesota Living with Heart Failure quality of life improved significantly (-3.7, 95% CI -7.1 to -0.3, p=0.03). 76% of patients preferred His-bundle pacing-on and 24% pacing-off (p Conclusion: His-bundle pacing did not increase peak oxygen uptake but, under double-blind conditions, significantly improved quality of life and was symptomatically preferred by the clear majority of patients. Ventricular pacing delivered via the His bundle did not adversely impact ventricular function during the 6 months.

Publication DOI: https://doi.org/10.1002/ejhf.2736
Divisions: College of Health & Life Sciences > Aston Medical School
Additional Information: Funding: HOPE-HF was an investigator-initiated trial, with the research activity funded by the British Heart Foundation. Excess costs to the NHS including His pacing leads, delivery sheaths and additional device costs were provided by Medtronic (Minneapolis, MN, USA) Copyright © 2022 The Authors.European Journal of Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
Publication ISSN: 1879-0844
Last Modified: 02 Dec 2024 08:50
Date Deposited: 24 Feb 2023 09:11
Full Text Link:
Related URLs: https://onlinel ... .1002/ejhf.2736 (Publisher URL)
PURE Output Type: Article
Published Date: 2022-11-20
Published Online Date: 2022-11-20
Accepted Date: 2022-11-09
Authors: Stegemann, Berthold (ORCID Profile 0000-0003-2841-8022)
Shun-Shun, Mathew
Whinnett, Zachary
Francis, Darrell

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