A Case Report of Permanent his Bundle Pacing in A Patient with LVEF Worsened after CRT

Abstract

Deleterious effects from chronic RV pacing have been well documented. Physiologic pacing-induced by cardiac resynchronization therapy (CRT) and His bundle pacing (HBP) appears to mitigate the deleterious structural and functional effects of RV pacing. Based on the above-mentioned evidence, in patients with atrioventricular block who have an indication for permanent pacing with a left ventricular ejection fraction (LVEF) between 36% and 50% and are expected to require ventricular pacing more than 40% of the time, it is reasonable to choose pacing methods that maintain physiologic ventricular activation (e.g., CRT or HBP) over right ventricular pacing according to current guidelines; however, it is not clear when to prefer CRT over HBP and vice versa. We report a case of a patient with ischemic dilated cardiomyopathy, low ejection fraction, and narrow QRS who had a further worsening of LVEF after CRT-D therapy for advanced atrioventricular block and sudden death prevention, in whom His bundle pacing was a reasonable solution.