Direct capture of the left bundle branch compared to left bundle branch area pacing deteriorates interventricular synchrony but improves left ventricular lateral wall depolarization duration

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
K Curila ◽  
P Jurak ◽  
P Waldauf ◽  
J Halamek ◽  
J Karch ◽  
...  
Keyword(s):  
Lateral Wall ◽  
Left Ventricular ◽  
Public Institution ◽  
Research Centre ◽  
Direct Capture ◽  
Funding Sources ◽  
Lead Placement ◽  
Septal Pacing ◽  
Ventricular Activation ◽  
Ventricular Depolarization

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): This paper was supported by the Charles University Research Centre program No. UNCE/MED/002 and 260530/SVV/2020 Background Direct and indirect pacing of the left bundle branch are novel pacing techniques preserving LV synchrony. Aim of the study was to compare differences in ventricular activation between them using an UHF-ECG. Methods The left septal lead placement was done in 68 patients with bradycardia. Four distinct ventricular captures were described; nonselective LBBp (nsLBBp), selective LBBp (sLBBp), paraLBBp and left bundle branch area capture (LBBap). The timings of local ventricular activations and local depolarization durations were displayed by the UHF-ECG. e-DYS was calculated as a difference between the first and last activation. Results There were 35 nsLBBp, 21 paraLBBp, 12 sLBBp and 96 LBBap obtained in 68 patients.  The nsLBBp compared to LBBap caused worse interventricular synchrony (e-DYS -23 ms (-28;-18) vs -12 ms (-17;-8), p < 0.001), but improved LV lateral wall depolarization duration. The sLBBp, nsLBBp and paraLBBp differed in e-DYS; -31 ms (-38;-24) vs -23 ms (-28;-17) vs -13 ms (-20;-7), p < 0.01 between each of them. Their left ventricular depolarization durations were the same, but they were longer when pacing resulted in the left axis deviation. If the direct capture of the LBB was not confirmed (LBBap), LV depolarization duration was deteriorated irrespective of the QSR morphology in the V1 or RWPT in the V5. Examples of UHF-ECG maps during LBBap, paraLBBp and nsLBBp are shown in Figure 1. Conclusions The direct capture of the left bundle branch deteriorates interventriclar synchrony but improves the depolarization duration of the left ventricular lateral wall compared to left ventricular myocardial septal pacing. Abstract Figure 1

scholarly journals Changes in mechanics of septal and lateral walls in patients with left bundle-branch block are related to extent of systolic dysfunction

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
K Kupczynska ◽  
KA Nguyen ◽  
E Surkova ◽  
CH Palermo ◽  
F Sambugaro ◽  
...  
Keyword(s):  
Left Bundle Branch Block ◽  
Systolic Dysfunction ◽  
Lateral Wall ◽  
Left Ventricular ◽  
Public Institution ◽  
Healthy Controls ◽  
Bundle Branch Block ◽  
Funding Sources ◽  
Lv Dysfunction ◽  
Artery Disease

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): Karolina Kupczynska was supported by research grant awarded by the Club 30 of the Polish Cardiac Society Background Left bundle branch block (LBBB) affects left ventricular (LV) mechanics and promotes systolic dysfunction. Purpose To analyse myocardial work (MW) and myocardial work efficiency (MWE) of the septal and LV lateral wall in healthy controls and LBBB patients with various degrees of LV dysfunction using non-invasive method. Methods Our study involved 102 healthy controls (mean age 41.5 ± 15.7 years, 45% male) and 58 LBBB patients without coronary artery disease (mean age 65 ± 13 years, 60% male) divided into 3 groups based on their LVEF: preserved (n= 27), mid-range (n= 16) and reduced (n= 15). Myocardial work parameters were estimated in septal and lateral wall by LV pressure-strain loop obtained by echocardiography. Results There were no differences between septal and lateral MW and MWE in healthy controls (p = NS). We found lower septal MW in comparison to lateral MW (p < 0.0001), but there were no differences in MWE (p = NS) in LBBB patients with preserved LVEF. Patients with LBBB and mid-range or reduced LVEF had lower MW (p < 0.0001 in both subgroups) and lower MWE (p = 0.002 and p = 0.0001, respectively) in septum compared with lateral wall. There was a progressive decrease in septal MW and MWE with the occurring of LBBB and the worsening of LVEF (figure A). Interestingly in healthy controls there was significantly lower lateral MW but higher MWE in comparison to group with LBBB and preserved LVEF. We did not detect differences between LBBB groups with preserved and mid-range LVEF, but patients with reduced LVEF had significant reduction in terms of lateral MW and MWE (figure B). Conclusions Impairment in septal myocardial work escalated according to the appearance of LBBB and LVEF loss. Septal dysfunction was compensated by the effective myocardial work of the lateral wall in LBBB patients with preserved and mid-range LVEF. Mechanical dysfunction of the lateral wall was associated with severely reduced LVEF. Abstract Figure.

scholarly journals Left Ventricular Myocardial Septal Pacing in Close Proximity to LBB Does Not Prolong the Duration of the Left Ventricular Lateral Wall Depolarization Compared to LBB Pacing

2021 ◽  
Vol 8 ◽  
Author(s):  
Karol Curila ◽  
Pavel Jurak ◽  
Kevin Vernooy ◽  
Marek Jastrzebski ◽  
Petr Waldauf ◽  
...  
Keyword(s):  
Lateral Wall ◽  
Left Ventricular ◽  
Close Proximity ◽  
Septal Pacing ◽  
Qrs Morphology ◽  
Interventricular Dyssynchrony ◽  
The Mean ◽  
The Difference ◽  
Ventricular Depolarization ◽  
Spontaneous Rhythm

Background: Three different ventricular capture types are observed during left bundle branch pacing (LBBp). They are selective LBB pacing (sLBBp), non-selective LBB pacing (nsLBBp), and myocardial left septal pacing transiting from nsLBBp while decreasing the pacing output (LVSP). Study aimed to compare differences in ventricular depolarization between these captures using ultra-high-frequency electrocardiography (UHF-ECG).Methods: Using decremental pacing voltage output, we identified and studied nsLBBp, sLBBp, and LVSP in patients with bradycardia. Timing of ventricular activations in precordial leads was displayed using UHF-ECGs, and electrical dyssynchrony (e-DYS) was calculated as the difference between the first and last activation. The durations of local depolarizations (Vd) were determined as the width of the UHF-QRS complex at 50% of its amplitude.Results: In 57 consecutive patients, data were collected during nsLBBp (n = 57), LVSP (n = 34), and sLBBp (n = 23). Interventricular dyssynchrony (e-DYS) was significantly lower during LVSP −16 ms (−21; −11), than nsLBBp −24 ms (−28; −20) and sLBBp −31 ms (−36; −25). LVSP had the same V1d-V8d as nsLBBp and sLBBp except for V3d, which during LVSP was shorter than sLBBp; the mean difference −9 ms (−16; −1), p = 0.01. LVSP caused less interventricular dyssynchrony and the same or better local depolarization durations than nsLBBp and sLBBp irrespective of QRS morphology during spontaneous rhythm or paced QRS axis.Conclusions: In patients with bradycardia, LVSP in close proximity to LBB resulted in better interventricular synchrony than nsLBBp and sLBBp and did not significantly prolong depolarization of the left ventricular lateral wall.

scholarly journals Comparison of QRSarea and left ventricular activation time during left bundle branch pacing and left ventricular septal pacing

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
LIB Heckman ◽  
JGK Luermans ◽  
K Curila ◽  
AMW Van Stipdonk ◽  
S Westra ◽  
...  
Keyword(s):  
Left Ventricular ◽  
Funding Sources ◽  
Septal Pacing ◽  
Ventricular Activation ◽  
Intrinsic Conduction ◽  
Qrs Morphology ◽  
Conversion Matrix ◽  
Qrs Duration ◽  
Normal Cardiac Function ◽  
Funding Acknowledgements

Abstract Funding Acknowledgements Type of funding sources: None. Background Left bundle branch area pacing (LBBAP) has recently been introduced as a novel physiological pacing strategy. Within LBBAP, distinction is made between left bundle branch pacing (LBBP) and left ventricular septal pacing (LVSP, no left bundle capture). Objective To compare acute electrocardiographic (ECG) and vectorcardiographic (VCG) effects of LBBP and LVSP as compared to intrinsic conduction. Methods In 50 patients with normal cardiac function and pacemaker indication for bradycardia, ECG characteristics of LBBP and LVSP were evaluated during RVSP and pacing at various depths in the septum: starting at the RV side of the septum: the last position with QS morphology, the first position with r’ morphology, LVSP and – in patients where LBB capture was achieved – LBBP. From the ECG’s QRS duration and QRS morphology in V1, and the stimulus-LVAT interval were measured. After conversion of the ECG into VCG (Kors conversion matrix), QRS area was calculated. Results In LVSP, QRS area significantly decreased from 82 ± 29 µVs during RVSP to 46 ± 12 µVs during LVSP. In patients where LBB capture was achieved QRS area significantly decreased from 78 ± 23 µVs to 38 ± 15 µVs in LBBP. In patients with LBB capture, QRS area was significantly smaller during LBBP compared to LVSP (figure A), but LVAT was not significantly different (figure B, p = 0.138). In patients with normal ventricular activation where LBBP was achieved (n = 20), QRS area was significantly larger during LVSP (48 ± 17) compared to LBBP (37 ± 16), the latter being not significantly different from normal intrinsic ventricular activation (35 ± 19 µVs). Conclusions ECG and VCG indices demonstrate that ventricular dyssynchrony is comparable but slightly more synchronous during LBBP compared to LVSP. Abstract Figure. QRS area and S-LVAT in LVSP and LBBP

scholarly journals Comparing Ventricular Synchrony in Left Bundle Branch and Left Ventricular Septal Pacing in Pacemaker Patients

2021 ◽  
Vol 10 (4) ◽  
pp. 822
Author(s):  
Luuk I.B. Heckman ◽  
Justin G.L.M. Luermans ◽  
Karol Curila ◽  
Antonius M.W. Van Stipdonk ◽  
Sjoerd Westra ◽  
...  
Keyword(s):  
Left Ventricular ◽  
Activation Time ◽  
Ventricular Synchrony ◽  
Septal Pacing ◽  
Ventricular Activation ◽  
Qrs Morphology ◽  
Conversion Matrix ◽  
Qrs Duration ◽  
The Right ◽  
Electrophysiological Effects

Background: Left bundle branch area pacing (LBBAP) has recently been introduced as a novel physiological pacing strategy. Within LBBAP, distinction is made between left bundle branch pacing (LBBP) and left ventricular septal pacing (LVSP, no left bundle capture). Objective: To investigate acute electrophysiological effects of LBBP and LVSP as compared to intrinsic ventricular conduction. Methods: Fifty patients with normal cardiac function and pacemaker indication for bradycardia underwent LBBAP. Electrocardiography (ECG) characteristics were evaluated during pacing at various depths within the septum: starting at the right ventricular (RV) side of the septum: the last position with QS morphology, the first position with r’ morphology, LVSP and—in patients where left bundle branch (LBB) capture was achieved—LBBP. From the ECG’s QRS duration and QRS morphology in lead V1, the stimulus- left ventricular activation time left ventricular activation time (LVAT) interval were measured. After conversion of the ECG into vectorcardiogram (VCG) (Kors conversion matrix), QRS area and QRS vector in transverse plane (Azimuth) were determined. Results: QRS area significantly decreased from 82 ± 29 µVs during RV septal pacing (RVSP) to 46 ± 12 µVs during LVSP. In the subgroup where LBB capture was achieved (n = 31), QRS area significantly decreased from 46 ± 17 µVs during LVSP to 38 ± 15 µVs during LBBP, while LVAT was not significantly different between LVSP and LBBP. In patients with normal ventricular activation and narrow QRS, QRS area during LBBP was not significantly different from that during intrinsic activation (37 ± 16 vs. 35 ± 19 µVs, respectively). The Azimuth significantly changed from RVSP (−46 ± 33°) to LVSP (19 ± 16°) and LBBP (−22 ± 14°). The Azimuth during both LVSP and LBBP were not significantly different from normal ventricular activation. QRS area and LVAT correlated moderately (Spearman’s R = 0.58). Conclusions: ECG and VCG indices demonstrate that both LVSP and LBBP improve ventricular dyssynchrony considerably as compared to RVSP, to values close to normal ventricular activation. LBBP seems to result in a small, but significant, improvement in ventricular synchrony as compared to LVSP.

47 Coronary venous anatomy and transvenous lead placement at the left ventricular lateral wall

EP Europace ◽  
2005 ◽  
Vol 7 (Supplement_1) ◽  
pp. 9-9
Author(s):  
M. Stockburger ◽  
H. Langreck ◽  
A. Nitardy ◽  
W. Haverkamp ◽  
R. Dietz
Keyword(s):  
Lateral Wall ◽  
Left Ventricular ◽  
Venous Anatomy ◽  
Lead Placement

scholarly journals Influences on myocardial perfusion in non-obstructive coronary disease: an observational quantitative perfusion mapping study

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
K Knott ◽  
A Seraphim ◽  
JB Augusto ◽  
C Camaioni ◽  
T Kotecha ◽  
...  
Keyword(s):  
Coronary Disease ◽  
Coronary Arteries ◽  
Clinical Training ◽  
Beta Blockers ◽  
Left Ventricular ◽  
Research Centre ◽  
Reference Ranges ◽  
Research Fellowship ◽  
Funding Sources ◽  
Rest Perfusion

Abstract Funding Acknowledgements Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): This study was supported by a Clinical Training Research Fellowship (K. Knott) from the British Heart Foundation and directly and indirectly from the Biomedical Research Centre at University College London Hospitals and Barts Heart Centre. Background Cardiovascular magnetic resonance (CMR) with automated inline perfusion mapping permits rapid fully automated non-invasive myocardial blood flow (MBF, ml/g/min). Understanding the microvascular component of MBF would help optimize epicardial coronary artery disease detection and potentially serve as an independent diagnostic / therapeutic target.  Purpose To explore MBF influences at stress and rest in patients with unobstructed epicardial coronary arteries. Methods 242 participants (mean age 56.9 years) from 5 European centers with unobstructed epicardial coronary arteries and no myocardial scar underwent adenosine vasodilator perfusion mapping at stress and rest. The factors influencing MBF were determined using univariate and multivariate linear regression analyses. Results Mean rest perfusion was 0.91+/-0.24ml/g/min. Rest perfusion was higher in females (0.97+/-0.22ml/g/min vs 0.83 +/- 0.24ml/g/min) and lower in patients on beta blockers. Mean stress MBF was 2.53+/-0.82ml/g/min. Factors independently associated with reduced stress MBF were increasing age, diabetes, increasing left ventricular mass (LVMi) and the use of beta blockers.  The predicted stress MBF can be obtained from the equation MBF = 2.66–0.015(age-60)–0.013(LVMi-57)-0.405(diabetes)–0.365(beta blocker). This means stress MBF falls 10% over 19 years and that diabetes drops the MBF by the equivalent of being 27 years older. These changes are large: for example, a 70-year-old diabetic would have 30% lower stress MBF than a 35 year-old non-diabetic.  Conclusions In the absence of obstructive epicardial coronary disease, stress MBF falls with age, diabetes, increased LV mass and beta-blockers. These data may help develop normal reference ranges, input to other modelling (eg CT FFR), and they advance perfusion mapping as a measure of microvascular function. Abstract Figure. Summary of the determinants of perfusion

scholarly journals Analysis of a large cohort of African/Afro-Caribbean patients by cardiac magnetic resonance

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
E Nakou ◽  
B Peters ◽  
D Bromage ◽  
P Kellman ◽  
D Sado ◽  
...  
Keyword(s):  
Heart Disease ◽  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Hypertensive Heart Disease ◽  
Lateral Wall ◽  
Left Ventricular ◽  
Specific Pattern ◽  
Funding Sources ◽  
Tertiary Centre ◽  
History Of

Abstract Funding Acknowledgements Type of funding sources: None. Background Limited data is available in the literature on Cardiac Magnetic Resonance (CMR) features of African/Afro-Caribbeans, in particular exploring differences between hypertensive heart disease (HHD) and hypertrophic cardiomyopathy (HCM).  Purpose To describe the cardiac morphology and pattern of late gadolinium enhancement (LGE) in patients of African/Afro-Caribbean origin.  Methods We retrospectively analysed African/Afro-Caribbean patients who underwent clinical CMR at a tertiary centre. Three groups were specifically investigated: HHD, HCM and combination of HHD and HCM or ambiguous (HHD&HCM).  Results Overall, 166 consecutive patients (58% male, mean age 55 ± 14yo) were analysed. One-hundred fifty-four (93%) had history of arterial hypertension (HTN), including 17 with uncontrolled/malignant HTN. Overall, 28(17%) had normal scans, 70(42%) HHD, 15(9%) apical HCM, 10(6%) classical septal HCM, 19(11%) dilated cardiomyopathy, 6(4%) cardiac amyloidosis, 3(2%) ischemic heart disease, 4(2%) myocarditis, 2 sarcoidosis and 1 valvular disease. In 7(4%) the diagnosis was ambiguous between HHD and HCM and 1 uncertain. Forty-four (27%) had dual pathology, most frequently HHD, bystander myocardial infarction (MI) and embolic MI. LGE was detected in 95(57%), 26 with ischemic pattern, 13 diffuse mid-wall, 29 focal non-ischemic and 28 diffuse/multifocal non-ischemic. CMR features and correlations between subgroups are reported in the Table. Patients with HHD had significantly higher left ventricular (LV) end-diastolic (ED) volume indexed (Vi) and LV end-systolic (ES) Vi, but lower LV ejection fraction (EF) and LV maximum wall thickness (MWT) compared to HCM patients. HHD&HCM had higher LVEF and MWT compared to HHD and higher LVEDVi compared to HCM. LGE was more frequently seen in HCM and HHD&HCM as focal non-ischemic (6vs5vs10,p = 0.049) and diffuse multifocal(5vs6vs9,p = 0.009). A history of uncontrolled/malignant HTN was more frequent in HHD and HHD&HCM (11vs1vs5,p = 0.025) and was associated with diffuse LGE with lateral wall involvement (p < 0.0001) (Figure). Conclusions: CMR findings in African/Afro-Caribbeans may overlap between aetiologies. A specific pattern of diffuse non-ischaemic LGE involving the lateral wall appears though to be more often associated with severe uncontrolled HTN. Table HHD(n = 70) HCM(n = 19) HHD&HCM or ambiguous (n = 13) p LVEDVi, ml/m2 88 ± 33 62 ± 11 77 ± 6 0.003 LVESVi, ml/m2 36 ± 26 16 ± 10 26 ± 19 0.002 LVEF, % 62 ± 16 79 ± 6 74 ± 12 0.567 LVMWT, mm 13 ± 2 15 ± 4 14 ± 3 <0.0001 CMR features and correlations between subgroups Abstract Figure

scholarly journals Novel approach to diagnosis of His bundle capture using individualized left ventricular lateral wall activation time as reference

2021 ◽  
Author(s):  
Marek Jastrzebski ◽  
Pawel Moskal ◽  
Piotr Kukla ◽  
Agnieszka Bednarek ◽  
Grzegorz Kielbasa ◽  
...  
Keyword(s):  
Roc Curve ◽  
Lateral Wall ◽  
Left Ventricular ◽  
Curve Analysis ◽  
Peak Time ◽  
Activation Time ◽  
Roc Curve Analysis ◽  
His Bundle ◽  
Novel Approach ◽  
Ventricular Activation

Background: During non-selective His bundle (HB) pacing, it is clinically important to confirm His bundle capture vs. right ventricular septal (RVS) capture. The present study aimed to validate the hypothesis that during HB capture left ventricular lateral wall activation time, approximated by the V6 R-wave peak time (V6RWPT), will not be longer than the corresponding activation time during native conduction. Methods: Consecutive patients with permanent HB pacing were recruited; cases with abnormal His-ventricle interval or left bundle branch block were excluded. Two corresponding intervals were compared: stimulus-V6RWPT and native HBpotential-V6RWPT. Difference between these two intervals (delta V6RWPT), diagnostic of lack of HB capture, was identified using receiver operating characteristic (ROC) curve analysis. Results: A total of 723 ECGs (219 with native rhythm, 172 with selective HB, 215 with non-selective HB, and 117 with RVS capture) were obtained from 219 patients. The native HB-V6RWPT, non-selective-, and selective-HB paced V6RWPT were nearly equal, while RVS V6RWPT was 32.0 (±9.5) ms longer. The ROC curve analysis indicated delta V6RWPT > 12 ms as diagnostic of lack of HB capture (specificity of 99.1% and sensitivity of 100%). A blinded observer correctly diagnosed 96.7% (321/332) of ECGs using this criterion. Conclusions: We validated a novel criterion for HB capture that is based on the physiological left ventricular activation time as an individualized reference. HB capture can be diagnosed when paced V6RWPT does not exceed the value obtained during native conduction by more than 12 ms, while longer paced V6RWPT indicates RVS capture.

scholarly journals Novel approach to diagnosis of His bundle capture using individualized left ventricular lateral wall activation time as reference

2021 ◽  
Author(s):  
Marek Jastrzebski ◽  
Pawel Moskal ◽  
Piotr Kukla ◽  
Agnieszka Bednarek ◽  
Grzegorz Kielbasa ◽  
...  
Keyword(s):  
Roc Curve ◽  
Lateral Wall ◽  
Left Ventricular ◽  
Curve Analysis ◽  
Peak Time ◽  
Activation Time ◽  
Roc Curve Analysis ◽  
His Bundle ◽  
Novel Approach ◽  
Ventricular Activation

Aims: During non-selective His bundle (HB) pacing, it is clinically important to confirm His bundle capture vs. right ventricular septal (RVS) capture. The present study aimed to validate the hypothesis that during HB capture left ventricular lateral wall activation time, approximated by the V6 R-wave peak time (V6RWPT), will not be longer than the corresponding activation time during native conduction. Methods: Consecutive patients with permanent HB pacing were recruited; cases with abnormal His-ventricle interval or left bundle branch block were excluded. Two corresponding intervals were compared: stimulus-V6RWPT and native HBpotential-V6RWPT. Difference between these two intervals (delta V6RWPT), diagnostic of lack of HB capture, was identified using receiver operating characteristic (ROC) curve analysis. Results: A total of 723 ECGs (219 with native rhythm, 172 with selective HB, 215 with non-selective HB, and 117 with RVS capture) were obtained from 219 patients. The native HB-V6RWPT, non-selective-, and selective-HB paced V6RWPT were nearly equal, while RVS V6RWPT was 32.0 (+/-9.5) ms longer. The ROC curve analysis indicated delta V6RWPT > 12 ms as diagnostic of lack of HB capture (specificity of 99.1% and sensitivity of 100%). A blinded observer correctly diagnosed 96.7% (321/332) of ECGs using this criterion. Conclusion: We validated a novel criterion for HB capture that is based on the physiological left ventricular activation time as an individualized reference. HB capture can be diagnosed when paced V6RWPT does not exceed the value obtained during native conduction by more than 12 ms, while longer paced V6RWPT indicates RVS capture.

scholarly journals Non-selective and selective His bundle pacing both preserve left ventricular activation time and pattern

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
A Arnold ◽  
MJ Shun-Shin ◽  
D Keene ◽  
JP Howard ◽  
J Chow ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Left Ventricular ◽  
Public Institution ◽  
Activation Time ◽  
His Bundle ◽  
His Bundle Pacing ◽  
Ventricular Activation ◽  
Qrs Duration ◽  
Left And Right ◽  
The Impact

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): British Heart Foundation Background: His bundle pacing can be achieved in two ways selective His bundle pacing, where the His bundle is captured alone, and non-selective His bundle pacing, where local myocardium is also captured resulting a pre-excited ECG appearance. We assessed the impact of this ventricular pre-excitation on left and right ventricular dys-synchrony. Methods We recruited patients who displayed both selective and non-selective His bundle pacing. We performed non-invasive epicardial electrical mapping to determine left and right ventricular activation times and patterns. Results In the primary analysis (n = 20, all patients), non-selective His bundle pacing did not prolong LVAT compared to select His bundle pacing by a pre-specified non-inferiority margin of 10ms (LVAT prolongation: -5.5ms, 95% confidence interval (CI): -0.6 to -10.4, non-inferiority p < 0.0001). Non-selective His bundle pacing did not prolong right ventricular activation time (4.3ms, 95%CI: -4.0 to 12.8, p = 0.296) but did prolong QRS duration (22.1ms, 95%CI: 11.8 to 32.4, p = 0.0003). In patients with narrow intrinsic QRS (n = 6), non-selective His bundle pacing preserved left ventricular activation time (-2.9ms, 95%CI: -9.7 to 4.0, p = 0.331) but prolonged QRS duration (31.4ms, 95%CI: 22.0 to 40.7, p = 0.0003) and mean right ventricular activation time (16.8ms, 95%CI: -5.3 to 38.9, p = 0.108) compared to selective His bundle pacing. Activation pattern of the left ventricular surface was unchanged between selective and non-selective His bundle pacing. Non-selective His bundle pacing produced early basal right ventricular activation, which was not observed with selective His bundle pacing. Conclusions Compared to selective His bundle pacing, local myocardial capture during non-selective His bundle pacing produces right ventricular pre-excitation resulting in prolongation of QRS duration. However, non-selective His bundle pacing preserves the left ventricular activation time and pattern of selective His bundle pacing. When choosing between selective and non-selective His bundle pacing, left ventricular dyssynchrony is not an important factor. Abstract Figure: Selective vs Non-Selective HBP

Sign in / Sign up

Export Citation Format

Share Document