Effect of Nonselective His Bundle Pacing on Delayed Myocardial Activation in Left-axis Deviation and Left Bundle Branch Block.
Nonselective His bundle pacing
left bundle branch block
left-axis deviation
Journal
The Journal of innovations in cardiac rhythm management
ISSN: 2156-3977
Titre abrégé: J Innov Card Rhythm Manag
Pays: United States
ID NLM: 101589872
Informations de publication
Date de publication:
Jul 2021
Jul 2021
Historique:
received:
07
03
2021
accepted:
06
04
2021
entrez:
19
7
2021
pubmed:
20
7
2021
medline:
20
7
2021
Statut:
epublish
Résumé
It has been suggested that nonselective His bundle pacing (NS-HBP) corrects terminal conduction delay in right bundle branch block by early excitation of the right ventricular free wall. A similar analysis of NS-HBP, in patients with left bundle branch block (LBBB) and left-axis deviation (LAD) has not been done. Therefore, we compared the baseline QRS parameters in LAD and LBBB during NS-HBP and selective HBP (S-HBP). In LAD patients (n = 16), NS-HBP normalized the QRS axis from -35° ± 10° to 30° ± 34° (p < 0.01) and increased the lead 1 voltage (L1V) from 0.55 ± 0.3 mV to 0.88 ± 0.2 mV (p < 0.001) without increasing the peak lateral wall activation time (PLWAT) (p = not significant). In 23 of 41 LBBB patients, NS-HBP decreased the prolonged PLWAT by 73 ms (p < 0.0001), resolved the mid-QRS notch, normalized the QRS axis, and increased the L1V from 0.5 ± 0.3 mV to 1.15 ± 0.3 mV (p < 0.0001). In the remaining 18 LBBB patients, NS-HBP did not resolve the mid-QRS notch; however, the peak septal activation time decreased by 45 ms (p < 0.0001), PLWAT decreased by 53 ms (p < 0.0001), L1V increased from 0.5 ± 0.3 mV to 0.87 ± 0.4 mV (p < 0.0001), and the QRS axis normalized. All patients who developed S-HBP at lower pacing showed uncorrected LBBB (n = 6) or LAD (n = 7). In conclusion, NS-HBP, which causes myocardial activation in advance of simultaneously initiated S-HBP, results in a paced QRS complex with a normal axis and shorter activation times and restores the L1V in patients with LAD and LBBB. In some patients, a mid-QRS notch was seen with NS-HBP, which suggests fusion with S-HBP, which conducts without LBBB correction. A higher L1V in association with a shorter PLWAT and a normal QRS axis suggests that a more organized degree of left ventricular activation occurs with NS-HBP as compared to LBBB.
Identifiants
pubmed: 34277128
doi: 10.19102/icrm.2021.120702
pii: icrm.2021.120702
pmc: PMC8221639
doi:
Types de publication
Journal Article
Langues
eng
Pagination
4577-4585Informations de copyright
Copyright: © 2021 Innovations in Cardiac Rhythm Management.
Déclaration de conflit d'intérêts
The authors report no conflicts of interest for the published content. This study was funded by a Medtronic ERP grant.
Références
Heart Rhythm. 2019 Dec;16(12):1791-1796
pubmed: 31233818
Heart Rhythm. 2018 Mar;15(3):460-468
pubmed: 29107697
Anat Rec (Hoboken). 2008 Feb;291(2):204-15
pubmed: 18085635
Circulation. 1977 Dec;56(6):996-1006
pubmed: 923070
Anat Rec (Hoboken). 2017 Oct;300(10):1793-1801
pubmed: 28605166
Heart Rhythm. 2015 Jul;12(7):1548-57
pubmed: 25828601
Circulation. 1983 Mar;67(3):660-4
pubmed: 6821910
Heart Rhythm. 2009 May;6(5):672-80
pubmed: 19328044
Europace. 2019 Nov 1;21(11):1694-1702
pubmed: 31322651
Am Heart J. 1962 Mar;63:346-61
pubmed: 13925313
Am Heart J. 1958 Apr;55(4):547-56
pubmed: 13533233
J Am Heart Assoc. 2013 Dec 19;2(6):e000246
pubmed: 24356527
Proc Natl Acad Sci U S A. 2005 Mar 15;102(11):4126-9
pubmed: 15753312
Circulation. 1973 Sep;48(3):556-64
pubmed: 4726238
Am J Cardiol. 2016 Aug 15;118(4):527-34
pubmed: 27344272
Heart. 2019 Jan;105(2):137-143
pubmed: 30093543
Circulation. 2019 Apr 16;139(16):1876-1888
pubmed: 30704273
J Electrocardiol. 1968;1(2):155-60
pubmed: 5707066
Heart Rhythm. 2018 Mar;15(3):413-420
pubmed: 29031929
Cell. 2017 Apr 20;169(3):510-522.e20
pubmed: 28431249
Heart Rhythm. 2020 Jan;17(1):123-130
pubmed: 31377422
J Cardiovasc Electrophysiol. 2020 Sep;31(9):2462-2473
pubmed: 32681681
Circulation. 1978 Mar;57(3):473-83
pubmed: 624157
Circulation. 1970 Jun;41(6):899-912
pubmed: 5482907
Heart Rhythm. 2019 Dec;16(12):1797-1807
pubmed: 31096064
J Electrocardiol. 2021 Jan-Feb;64:58-65
pubmed: 33341724
Am J Cardiol. 2011 Mar 15;107(6):927-34
pubmed: 21376930