Permanent direct his bundle pacing does not induce ventricular dyssynchrony unlike conventional right ventricular apical pacing
- 239 Downloads
Benefits of A-V synchrony during right ventricular apical pacing are neutralized by induction of ventricular dyssynchrony. Only a few data are reported about direct His bundle pacing influence on ventricular synchronism.
Was to assess the capability of direct His bundle pacing to prevent pacing-induced ventricular dyssynchrony comparing DDD- (or VVI- in case of Atrial Fibrillation) right ventricular apical pacing with DDD- (or VVI-) direct His bundle pacing in the same patients cohort.
23 of 24 patients (mean age 75.1 ± 6.4 years) with narrow QRS (HV < 65 ms) underwent permanent direct His bundle pacing for “brady–tachy syndrome” (11) or supra-Hisian II/III-degree AV Block (permanent atrial fibrillation 7, AV Node ablation 1). A 4.1 F screw-in lead was fixed in His position, guided by endocardial pacemapping and unipolar recordings. Additional permanent (13 patients) or temporary right ventricular apical pacing leads were also positioned. Inter- and left intra-ventricular dyssynchrony, mitral regurgitation and left systolic ventricular function Tei index were assessed during either direct His bundle pacing or right ventricular apical pacing.
Permanent direct His bundle pacing was obtained in 23 of 24 patients. Indexes of ventricular dyssynchrony were drastically reduced, mitral regurgitation decreased and left systolic ventricular function Tei index improved during direct His bundle pacing (or His bundle and septum pacing) in comparison to apical pacing (p < 0.05). No statistically significant differences were observed between direct His bundle pacing and combined His bundle and septum pacing.
Direct His bundle pacing (also fused with adjacent septum capture) prevents pacing-induced ventricular dyssynchrony.
KeywordsHis bundle pacing His bundle Brady Tachy sick sinus syndrome SupraHisian AV block Cardiac pacing Ventricular dyssynchrony
Unable to display preview. Download preview PDF.
- 2.Connolly, S. J., Kerr, C. R., Gent, M., et al. (2000). Effects of physiologic pacing versus ventricular pacing on the risk of stroke and death due to cardiovascular causes. Canadian trial of physiologic pacing investigators. New England Journal of Medicine, 342(19), 1385–1391.CrossRefPubMedGoogle Scholar
- 4.Nielsen, J. C., Kristensen, L., Andersen, H. R., Mortensen, P. T., Pedersen, O. L., & Pedersen, A. K. (2003). A randomized comparison of atrial and dual-chamber pacing in 177 consecutive patients with sick sinus syndrome: Echocardiographic and clinical outcome. Journal of the American College of Cardiology, 42(4), 614–623.CrossRefPubMedGoogle Scholar
- 5.Sweeney, M. O., Hellkamp, A. S., Ellenbogen, K. A., et al. (2003). Mode selection trial investigators. Adverse effect of ventricular pacing on heart failure and atrial fibrillation among patients with normal baseline QRS duration in a clinical trial of pacemaker therapy for sinus node dysfunction. Circulation, 107(23), 2932–2937.CrossRefPubMedGoogle Scholar
- 21.Schiller, N. B., Shah, P. M., Crawford, M., et al. (1989). Recommendations for quantitation of the left ventricle by two-dimensional echocardiography. Journal of American Society of Echocardiography, 2, 358–367.Google Scholar
- 27.Tei, C., Nishimura, R. A., Seward, J. B., & Tajik, A. J. (1997). Noninvasive doppler-derived myocardial performance index: Correlation with simultaneous measurements of cardiac catheterisation measurements. Journal of the American Society of Echocardiography, 10(2), 169–178.CrossRefPubMedGoogle Scholar
- 29.Vassallo, J. A., Cassidy, D. M., Miller, J. M., Buxton, A. E., Marchlinski, F. E., & Josephson, M. E. (1986). Left ventricular endocardial activation during right ventricular pacing: Effect of underlying heart disease. Journal of the American College of Cardiology, 7(6), 1228–1233.PubMedGoogle Scholar
- 31.Yu, C. C., Lin, L. C., Lu, Y. B., Lin, M. S., Wang, J. Y., & Lin, J. L. (2005). Preservation of left ventricular contractile synchronism and diastolic function by right ventricular septal pacing: Implications from tissue Doppler imaging analysis. Circulation, 112(17), II-594 (abstr 2812).Google Scholar
- 32.Occhetta, E., Bortnik, M., Magnani, A., et al. (2006). 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, 47, 1938–1945.CrossRefPubMedGoogle Scholar