scholarly journals His-bundle and left bundle pacing with optimized atrioventricular delay achieve superior electrical synchrony over endocardial and epicardial pacing in left bundle branch block patients

Heart Rhythm ◽  
2020 ◽  
Vol 17 (11) ◽  
pp. 1922-1929 ◽  
Author(s):  
Marina Strocchi ◽  
Angela W.C. Lee ◽  
Aurel Neic ◽  
Julien Bouyssier ◽  
Karli Gillette ◽  
...  
Keyword(s):  
Left Bundle Branch Block ◽  
Bundle Branch Block ◽  
His Bundle ◽  
Atrioventricular Delay ◽  
Epicardial Pacing

Atrioventricular shortening is the dominant mechanism of benefit of biventricular pacing in left bundle branch block

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
A Arnold ◽  
MJ Shun-Shin ◽  
N Ali ◽  
JP Howard ◽  
D Keene ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Systolic Blood Pressure ◽  
Left Bundle Branch Block ◽  
Biventricular Pacing ◽  
Bundle Branch Block ◽  
His Bundle ◽  
His Bundle Pacing ◽  
Atrioventricular Delay ◽  
Ventricular Activation ◽  
The Mean

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): British Heart Foundation Background Cardiac resynchronization therapy delivered via biventricular pacing is thought to improve haemodynamic function through resynchronization of ventricular activation. Biventricular pacing also improves ventricular filling by shortening atrioventricular delay. Quantifying the relative contributions of these two mechanisms requires atrioventricular delay to be altered while left bundle branch block is preserved. This occurs when the His bundle is paced at an output below the left bundle branch block correction threshold. Purpose We performed His bundle pacing with preservation of left bundle branch block to measure the relative contributions of atrioventricular delay shortening and ventricular resynchronisation to the overall haemodynamic benefit of biventricular pacing. Methods Patients with left bundle branch block referred for conventional cardiac resynchronization therapy with biventricular pacing were recruited. Using a high precision, beat-by-beat systolic blood pressure assessment protocol, we assessed the haemodynamic effects of biventricular pacing and temporary His bundle pacing with left bundle branch block preservation at a full range of atrioventricular delays. We used non-invasive epicardial mapping (ECGI) to assess left ventricular activation time. Left bundle branch block preservation was defined as <20ms shortening of the interval between intrinsic His potential to QRS offset to the interval from stimulation to QRS offset in His bundle pacing. Results In 19 patients, His bundle pacing with preservation of left bundle branch block produced a peak systolic blood pressure improvement of 5.1mmHg (95% confidence interval: 2.2 to 8.0, p = 0.0013) compared to AAI pacing. In 16 of these patients, biventricular pacing was performed and produced a peak systolic blood pressure improvement of 7.1mmHg (3.8 to 10.4, p < 0.001) compared to AAI pacing. The mean within-patient improvement in systolic blood pressure from His bundle pacing with preservation of left bundle branch block to biventricular pacing was 2.6mmHg (-0.4 to 5.7, p = 0.053, n = 16). The mean improvement in systolic blood pressure with left bundle branch block-preserved His bundle pacing was 63% of the mean improvement with biventricular pacing. Change in left ventricular activation time from intrinsic rhythm to 12-lead-ECG-defined left bundle branch block preservation was 0.1ms (-6.4 to 6.7, n = 19). Conclusion Biventricular pacing in left bundle branch block improves haemodynamic function through ventricular resynchronization and shortening of atrioventricular delay. The majority of benefit appears to be produced by atrioventricular delay shortening. When left bundle branch block is not corrected, His bundle pacing may still produce considerable haemodynamic improvement through this mechanism. Abstract Figure.

Electrocardiographic characteristics of distal His bundle pacing in a patient with left bundle branch block

2019 ◽  
Vol 42 (12) ◽  
pp. 1594-1596 ◽  
Author(s):  
Min Gu ◽  
Yiran Hu ◽  
Wei Hua ◽  
Hongxia Niu ◽  
Xiaohong Zhou ◽  
...  
Keyword(s):  
Left Bundle Branch Block ◽  
Bundle Branch Block ◽  
His Bundle ◽  
His Bundle Pacing

scholarly journals His-Bundle Pacing in a Patient with Transcatheter Aortic Valve Implantation-Induced Left Bundle Branch Block

2018 ◽  
Vol 2018 ◽  
pp. 1-5 ◽  
Author(s):  
Jonathan Sen ◽  
Michael Mok ◽  
Mark Perrin
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Transcatheter Aortic Valve Implantation ◽  
Left Bundle Branch Block ◽  
Bundle Branch Block ◽  
His Bundle ◽  
His Bundle Pacing ◽  
Transcatheter Aortic Valve ◽  
Aortic Valve Implantation ◽  
Valve Implantation

Transcatheter aortic valve implantation (TAVI) is an effective intervention for severe aortic stenosis in patients at intermediate or high surgical risk, but damage to the native conduction system such as left bundle branch block (LBBB) may offset its benefits. New onset LBBB is associated with a higher risk of cardiovascular morbidity and mortality. His-bundle pacing (HBP) may be useful to treat TAVI-induced LBBB but has yet to be reported. We present the case of a 76-year-old man with severe symptomatic aortic stenosis treated with TAVI. His preoperative electrocardiogram showed sinus rhythm with a narrow QRS complex. Insertion of a CoreValve Evolut R transcatheter aortic valve was uneventful apart from the development of LBBB with a long PR interval. A dual-lead DDD pacemaker was implanted via the left cephalic vein on the following day. HV was mildly prolonged at 60 ms. Capture of the proximal His restored AV synchrony without correction of LBBB. Repositioning of the lead with capture of the left bundle branch enabled complete ventricular resynchronisation with a single lead. Our case demonstrates that LBBB in the setting of TAVI may be corrected by HBP.

Electrocardiographic patterns predictive of left bundle branch block correction with His bundle pacing

2020 ◽  
Vol 43 (11) ◽  
pp. 1318-1324
Author(s):  
Pablo Moriña‐Vázquez ◽  
Maria Teresa Moraleda‐Salas ◽  
Álvaro Arce‐León ◽  
Juan Manuel Fernández‐Gómez ◽  
José Venegas‐Gamero ◽  
...  
Keyword(s):  
Left Bundle Branch Block ◽  
Bundle Branch Block ◽  
His Bundle ◽  
His Bundle Pacing

scholarly journals The use of His bundle pacing for the treatment of painful left bundle branch block syndrome

2020 ◽  
Vol 8 (6) ◽  
pp. 1025-1029
Author(s):  
Kevin Andrew Smith ◽  
Julie Frey ◽  
Amber McKenzie ◽  
Kyle Hornsby ◽  
John Strobel
Keyword(s):  
Left Bundle Branch Block ◽  
Bundle Branch Block ◽  
His Bundle ◽  
His Bundle Pacing

6119Correction of transcatheter aortic valve replacement induced left bundle branch block by His bundle pacing

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
J De Pooter ◽  
S Calle ◽  
M Coeman ◽  
T Philipsen ◽  
P Gheeraert ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Left Bundle Branch Block ◽  
Transcatheter Aortic Valve Replacement ◽  
Permanent Pacemaker ◽  
Bundle Branch Block ◽  
His Bundle ◽  
His Bundle Pacing ◽  
Transcatheter Aortic Valve ◽  
Qrs Duration

Abstract Background Left bundle branch block (LBBB) occurs frequently after transcatheter aortic valve replacement (TAVR) and is associated with increased risk of permanent pacemaker implantation, heart failure hospitalization and sudden cardiac death. This pilot study explored the feasibility of TAVR-induced LBBB correction with His bundle pacing (HBP). Methods Patients with TAVR -induced LBBB and postoperative need for permanent pacemaker implant were planned for electrophysiology study and HBP. Patients with persistent high degree AV-block were excluded. HBP was performed using the Select Secure pacing lead, delivered through a fixed curve or a deflectable sheath. Successful HBP was defined as correction of LBBB by selective or non-selective HBP with LBBB correction thresholds less than 3.5V at 1.0ms at implant. Results The study enrolled 6 patients (mean age 85±2.5 years, 50% male). Mean QRS duration was 152±10ms, PR-interval 212±12ms AH-interval 166±16ms and HV-interval 62±12ms. Successful HBP was achieved in 5/6 (83%) patients. Mean QRS duration decreased from 153±11ms to 88±14ms (p=0.002). At implantation, mean threshold for LBBB correction was 1.6±1.0V (unipolar) and 2.2±1.3V (bipolar) at 1.0ms. Periprocedural, two complete AV-blocks occurred, both spontaneously resolved by the end of the procedure. Thresholds remained stable at 1 month follow up: 1.8±1.0V (unipolar) and 2.3±1.5V (bipolar) at 1.0ms. Figure 1 Conclusion Permanent His bundle pacing can safely correct TAVR-induced LBBB in the majority of patients. Further studies are needed to assess potential benefits of His bundle pacing over conventional right ventricular pacing in this population.

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