Eficácia da estimulação hissiana e septal profunda comparada à estimulação cardíaca convencional: revisão de literatura
Série temática: Avaliação de Tecnologias em Saúde Hospitalar (ATS-H)
DOI:
https://doi.org/10.34019/1982-8047.2023.v49.42846Keywords:
Artificial Cardiac Pacing, Cardiac Conduction System Disease, Efficiency, Quality of Health CareAbstract
Introduction: Patients with heart failure and diseases of cardiac condition need devices to control the heartbeat, such as a permanent pacemaker, cardiac resynchronization device or implantable cardioverter defibrillator. Right ventricular stimulation (RVP) has been the conventional treatment, however, studies demonstrate evidence related to ventricular dyssynchrony, reduced cardiac function, recurrence of atrial fibrillation and increased mortality. Knowledge of the harmful effects of traditional techniques justifies carrying out this research to prove whether Hissian or His-Purkinje (HPB) stimulation is a technique that produces more physiological activation with more synchronized ventricular activation. Objectives: To evaluate the efficacy and safety of Hissian stimulation compared to conventional treatment. Methods: PICO question prepared: P - Patients with indication for implantable electronic cardiac devices; I - Hissan Stimulation; C - Right Ventricular Stimulation; O - QRS complex duration, ejection fraction, ventricular diameter and NYHA functional class. The MEDLINE search platforms were searched via Pubmed, Cochrane Database of Systematic Reviews (COCHRANE) and Latin America and Caribbean Health Science Literature Database (LILACS). The searches were carried out in March 2023, by three independent reviewers. Results: The seven clinical trials included compared the HPB versus RVP techniques in relation to the electrocardiographic parameter, QRS complex duration, and three studies found a significantly better result in the intervention group. For echocardiographic results, evaluating ejection fraction, two studies had significantly better results in the HPB group. In relation to risk of bias, out of the seven studies included, only two presented low and medium risk, four presented high risk in one, two or three items evaluated. Conclusions: The HPB technique has demonstrated superiority to the conventional technique, however, randomized clinical trials of higher methodological quality and systematic reviews are needed to veriify the clinical effectiveness of the technique, involving more patients and longer follow-up time.
Downloads
References
Rohde LEP, Montera MW, Bocchi EA, Calusell NA, Albuquerque DC et al. Diretriz brasileira de insuficiência cardíaca crônica e aguda. Arq Bras Cardiol. 2018; 111(3):436–539.
Ziaeian B, Fonarow GC. Epidemiology and aetiology of heart failure. Nature Reviews Cardiology. 2016; 13:368-78.
Teixeira RA, Fagundes AA, Baggio JM, Oliveira JC, Medeiros PTJ et al. Diretriz brasileira de dispositivos cardíacos eletrônicos implantáveis: 2023. Arq Bras Cardiol. 2023; 120(1):e20220892.
Jeindi R, Wernly B. His-bundle-pacing for patients requiring a permanent pacemaker or cardiac resynchronisation: systematic review. AIHTA Decision Support Document. 2022:132.
Liu Q, Yang J, Bolun Z et al. Comparison of cardiac function between left bundle branch pacing and right ventricular outflow tract septal pacing in the short-term: a registered controlled clinical trial. International Journal of Cardiology. 2021; 322:70-6.
Vijayaraman P, Bordachar P, Ellenbogen KA. The continued search for physiological pacing: where are we now? Journal of the American College of Cardiology. 2017; 69:3099-114.
Abdelrahman M, Subzposh FA, Beer D et al. Clinical outcomes of His bundle pacing compared to right ventricular pacing. Journal of the American College of Cardiology. 2018; 71:2319-30.
Vijayaraman P, Herweg B, Verma A et al. Rescue left bundle branch area pacing in coronary venous lead failure or nonresponse to biventricular pacing: Results from International LBBAP Collaborative Study Group. Heart Rhythm. 2022; 19:1272-80.
Vijayaraman P, Chung MK, Dandamudi G et al. His bundle pacing. Journal of the American College of Cardiology. 2018; 72:927-47.
Joanna Briggs Institute. JBI levels of evidence. JBI; 2013.
Whinnett ZI, Shun-Shin MJ, Tanner M et al. Effects of haemodynamically atrio-ventricular optimized His bundle pacing on heart failure symptoms and exercise capacity: the His Optimized Pacing Evaluated for Heart Failure (HOPE-HF) randomized, double-blind, cross-over trial. European Journal of Heart Failure. 2023; 25:274-83.
Zhang J, Guo J, Hou X et al. Comparison of the effects of selective and non-selective His bundle pacing on cardiac electrical and mechanical synchrony. Europace. 2018; 20:1010-7.
Sun Z, Di B, Gao H et al. Assessment of ventricular mechanical synchronization after left bundle branch pacing using 2-D speckle tracking echocardiography. Clinical Cardiology. 2020; 43: 1562-72.
Li Y, Tian H, Zhang J et al. Effects of His bundle pacing and right ventricular apex pacing on cardiac electrical and mechanical synchrony and cardiac function in patients with heart failure and atrial fibrillation. American Journal of Translational Research. 2021; 13:3294-301.
Zhang S, Zhou X, Gold MR. Left bundle branch pacing: JACC review topic of the week. Journal of the American College of Cardiology. 2019; 74:3039-49.
Wang S, Wu S, Xu L et al. Feasibility and efficacy of his bundle pacing or left bundle pacing combined with atrioventricular node ablation in patients with persistent atrial fibrillation and implantable cardioverter-defibrillator therapy. Journal of the American Heart Association. 2019; 8:1-12.
Occhetta E, Bortnik M, Magnani A et al. Prevention of ventricular desynchronization by permanent para-hisian pacing after atrioventricular node ablation in chronic atrial fibrillation: a crossover, blinded, randomized study versus apical right ventricular pacing. Journal of the American College of Cardiology. 2006; 47:1938-45.
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; 16:1189-96.
Tang J, Chen S, Liu L et al. Assessment of permanent selective his bundle pacing in left ventricular synchronization using 3-D speckle tracking echocardiography. Ultrasound in Medicine and Biology. 2019; 45:385-94.
Das A, Chatterjee S. Feasibility of RA–LV pacing in patients with symptomatic left bundle branch block: a pilot study. Heart and Vessels. 2019; 34:1552-8.
Cheng LT, Zhang JM, Wang ZF et al. Recent approaches to His-Purkinje system pacing. Chinese Medical Journal. 2019; 132:190-6.
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. Circulation: Arrhythmia and Electrophysiology. 2018; 11:1-10.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2024 Liliane Barreto Teixeira, Saulo Pereira Costa, Sérgio Antônio Zullo, Thaís Santos Guerra Stacciarini, Luciane Fernanda Rodrigues Martinho Fernandes
This work is licensed under a Creative Commons Attribution 4.0 International License.
Cessão de Primeira Publicação à HU Revista
Os autores mantém todos os direitos autorais sobre a publicação, sem restrições, e concedem à HU Revista o direito de primeira publicação, com o trabalho licenciado sob a Licença Creative Commons Attribution que permite o compartilhamento irrestrito do trabalho, com reconhecimento da autoria e crédito pela citação de publicação inicial nesta revista, referenciando inclusive seu DOI.
