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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) \u226440%, PR interval \u2265200\u2009ms and either QRS \u2264140\u2009ms or right bundle branch block.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>Patients had atrial and His bundle leads implanted (and an implantable cardioverter-defibrillator lead if clinically indicated) and were randomized to 6\u2009months of pacing and 6\u2009months 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 were randomized: 90% men, 69\u2009\u00b1\u200910\u2009years, QRS duration 124\u2009\u00b1\u200926\u2009ms, PR interval 249\u2009\u00b1\u200959\u2009ms, LVEF 33\u2009\u00b1\u20099%. Neither peak oxygen uptake (+0.25\u2009ml\/kg\/min, 95% confidence interval [CI] \u22120.23 to +0.73, p =\u20090.3) nor LVEF (+0.5%, 95% CI \u22120.7 to 1.6, p =\u20090.4) changed with pacing but Minnesota Living with Heart Failure quality of life improved significantly (\u22123.7, 95% CI \u22127.1 to \u22120.3, p =\u20090.03). Seventy-six percent of patients preferred His bundle pacing-on and 24% pacing-off (p &amp;lt;\u20090.0001).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ejhf.2736","type":"journal-article","created":{"date-parts":[[2022,11,20]],"date-time":"2022-11-20T23:30:40Z","timestamp":1668987040000},"page":"274-283","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":50,"title":["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"],"prefix":"10.1093","volume":"25","author":[{"given":"Zachary I.","family":"Whinnett","sequence":"first","affiliation":[{"name":"National Heart and Lung Institute, Imperial College London , London ,","place":["UK"]},{"name":"Imperial College Healthcare NHS Trust , London 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