ABSTRACT
Resumen La terapia de resincronización cardiaca mediante estimulación hisiana ha demostrado ser efectiva en pacientes con bloqueo de rama izquierda del haz de His e insuficiencia cardiaca. Paciente masculino, con 47 años de edad, con insuficiencia cardiaca, fracción de expulsión del 17% y miocardio dilatada idiopática, electrocardiograma en ritmo sinusal, bloqueo auriculoventricular de 1.er grado, intervalo PR 400 ms, bloqueo completo de rama derecha del haz de His, bloqueo del fascículo anterior de la rama izquierda del haz de His, duración del QRS 200 ms. Se decidió realizar estimulación selectiva del haz de His. La resincronización cardiaca biventricular convencional en pacientes con presencia de bloqueo completo de la rama derecha del haz de His no está indicada debido a la pobre respuesta al tratamiento. La estimulación hisiana permite reclutar la rama bloqueada y reestablecer la conducción a través de ella, de tal forma que, en ausencia de necrosis, se logre sincronía biventricular. En el caso presentado el reclutamiento de la rama derecha mediante estimulación hisiana se reflejó en el restablecimiento de la sincronía biventricular, medida por rastreo de marcas (speckle tracking) e incremento significativo de la fracción de expulsión del ventrículo izquierdo del 17 al 36.6%, con un incremento absoluto del 19.6%.
Abstract Cardiac resynchronization therapy has proven to be an effective therapy in patients with left bundle branch block and heart failure. Male, 47 years old, heart failure with a left ventricle ejection fraction of 17%, idiopathic heart failure. ECG with sinus rhythm, 1st degree AV block, PR 400 ms, complete right bundle branch block, anterior hemi-fascicle of the left bundle of His, and QRS duration 200 ms. We decided to perform a selective His bundle pacing. In patients with right bundle branch block the biventricular cardiac resynchronization is not indicated due to low treatment response. His bundle pacing allows recruiting the blocked branch and restoring conduction throughout it, therefore, in the absence of necrosis the biventricular synchrony is achieved. We presented a case of His bundle pacing with recruitment of the right bundle branch, which reestablish biventricular synchrony measured by speckle tracking, and with a significant increase of the left ventricle ejection fraction from 17 to 36.6%, with an absolute increase of 19.6%.
Subject(s)
Humans , Male , Middle Aged , Bundle-Branch Block/therapy , Bundle of His , Cardiac Resynchronization Therapy , Bundle-Branch Block/complications , Heart Failure/complicationsABSTRACT
There is a paucity of experience regarding His bundle pacing (HBP) at laboratories initially attempting the procedure, especially in the Indian scenario. Patient who underwent HBP were selected for pacing therapy or in lieu of cardiac resynchronization therapy (CRT) at a single center. Among 22 patients attempted, 19 patients underwent successful implant, achieving selective HBP in 14 patients. There was a significant improvement in left ventricular ejection fraction (LVEF) (49.3 ± 9.3 vs. 36.7 ± 9.2) in the LV dysfunction subgroup (n = 6). Over a follow-up of 15 ± 6.5 months, thresholds were stable in all except one patient, and there was no requirement of lead revision. In summary, we found that HBP is a feasible option for achieving physiological pacing.
ABSTRACT
Objective To summarize the nursing experience of left atrial appendage occlusion combined with his bundle lifting pacing in the treatment of atrial fibrillation. Methods The heart center of our hospital was first created with left atrial appendage combined with hirson bundle pacing, and 5 cases were completed from January 1, 2017 to January 1, 2018, and the nursing points were summed up in combination with the perioperative and postoperative follow-up nursing. Results All 5 patients were successfully performed with combined operation, and no serious complications occurred during the perioperative period and follow-up period. Conclusions Because the process of innovation is more complicated, it is necessary for the nursing team to carry out strict auxiliary nursing and monitoring of the disease in different stages so as to ensure the operation safety and improve the quality of life of the patients.
ABSTRACT
Objective To explore the optimal perioperative nursing program for patients receiving cardiac pacemaker by His bundle pacing or by para-His bundle pacing.Methods A total of 26 patients,who were receiving cardiac pacemaker by His bundle pacing or by para-His bundle pacing,were enrolled in this study.The bundle of cares,used as the nursing intervention measures,was executed in all patients,which included strengthening the professional training for specialist team members,improvement of preoperative intervention,careful intraoperative cooperation,postoperative observation of patient's condition and complications,prevention and health guidance,etc.Results Through the strict implementation of the special bundle of nursing cares,all the 26 patients could well cooperated with surgical procedure,and after the treatment the patients recovered smoothly and achieved the desired results with no occurrence of complications.Conclusion The intervention measures of the bundle of cares are scientific and reasonable.The implementation of the special bundle of nursing cares can promote the professional nursing ability of nurses and ensure the quality of nursing service.