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 (original) (raw)

European Journal of Heart Failure

AimsExcessive prolongation of PR interval impairs coupling of atrio‐ventricular (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 a double‐blind cross‐over fashion, in patients with heart failure, left ventricular ejection fraction (LVEF) ≤40%, PR interval ≥200 ms and either QRS ≤140 ms or right bundle branch block.Methods and resultsPatients had atrial and His bundle leads implanted (and an implantable cardioverter‐defibrillator 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. Overall, 167 patients we...