Longitudinal dissociation and transition in thickness of the His‐Purkinje system cause various QRS waveforms of surface ECG under His bundle pacing: A simulation study based on clinical observations

2019 ◽  
Vol 30 (11) ◽  
pp. 2582-2590
Author(s):  
Jun‐ichi Okada ◽  
Katsuhito Fujiu ◽  
Takumi Washio ◽  
Seiryo Sugiura ◽  
Toshiaki Hisada ◽  
...  
Keyword(s):  
Simulation Study ◽  
His Bundle ◽  
His Bundle Pacing ◽  
Clinical Observations ◽  
Purkinje System ◽  
Surface Ecg ◽  
Longitudinal Dissociation

Junctional beats and pure His bundle pacing: Surface ECG appraisal in an atypical preexcitation variant

2019 ◽  
Vol 57 ◽  
pp. 35-38
Author(s):  
Hussam Ali ◽  
Sara Foresti ◽  
Elisabetta Mariucci ◽  
Riccardo Cappato
Keyword(s):  
His Bundle ◽  
His Bundle Pacing ◽  
Surface Ecg

Voltage dependent conduction abnormalities in His bundle pacing in patients without His Purkinje system disease

2020 ◽  
Vol 59 ◽  
pp. 1-6 ◽  
Author(s):  
Rehan Mahmud ◽  
Shakeel Jamal ◽  
Mohamed Musheinesh
Keyword(s):  
His Bundle ◽  
His Bundle Pacing ◽  
System Disease ◽  
Purkinje System ◽  
Conduction Abnormalities ◽  
Voltage Dependent

Abstract 17180: Longitudinal Dissociation in the His Bundle: Persistent Bundle Branch Block Can be Corrected by Permanent His Bundle Pacing

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Pugazhendhi Vijayaraman ◽  
Kenneth A Ellenbogen ◽  
Gopi Dandamudi
Keyword(s):  
Main Body ◽  
Exclusion Criteria ◽  
Pacing Threshold ◽  
Bundle Branch Block ◽  
His Bundle ◽  
His Bundle Pacing ◽  
Number Of Patients ◽  
Pacing Lead ◽  
Qrs Duration ◽  
Longitudinal Dissociation

Introduction: Focal disease in the main body of the His bundle (HB) is the cause for majority of the bundle branch block (BBB) patterns on EKG. Temporary distal HB pacing (HBP) has previously been shown to correct BBB in high number of patients. Anecdotal reports have confirmed abolition of BBB by permanent HBP. Hypothesis: The aim of our study is to report the incidence of correction of BBB during permanent HBP in patients undergoing pacemaker (PM) implantation. Methods: Permanent HBP was attempted in 185 patients referred for PM implantation. Pts with QRS duration (d) ≥110 ms and BBB were included in the study. Pts with normal QRS or CHB were excluded. HBP was performed using the Medtronic SelectSecure 3830 pacing lead. Baseline QRSd, paced QRSd, correction of BBB and HB pacing threshold were recorded. Results: Fifty patients met the inclusion-exclusion criteria. Mean age 73±12 yrs; men 65%, HTN 81%, DM 30%, CAD 38%, AF 42%, SSS 39%, AV disease 61%, RBBB 31, LBBB 14, IVCD 5). Permanent HBP was successful in correcting BBB in 42 (84%) patients. Underlying BBB was corrected by HBP in 29 of 31 (94%) patients with RBBB; 11 of 14 (79%) patients with LBBB; 1 of 5 (20%) patients with IVCD. Baseline QRSd improved from 141±15 ms to 124±17 ms. HBP threshold at implant was 1.5±1.3 V @ 0.5 ms. Conclusions: Permanent HBP corrected underlying BBB in the vast majority of patients with right or left BBB (40 of 45, 89%) compared to only 1 of 5 (20%) patients with IVCD. This confirms that focal disease in the main HB is the cause for BBB in the patients referred for PM implantation.

scholarly journals Normalization of bundle branch block patterns by distal His bundle pacing. Clinical and experimental evidence of longitudinal dissociation in the pathologic his bundle.

Circulation ◽  
1978 ◽  
Vol 57 (3) ◽  
pp. 473-483 ◽  
Author(s):  
N El-Sherif ◽  
F Amay-Y-Leon ◽  
C Schonfield ◽  
B J Scherlag ◽  
K Rosen ◽  
...  
Keyword(s):  
Experimental Evidence ◽  
Bundle Branch Block ◽  
His Bundle ◽  
His Bundle Pacing ◽  
Longitudinal Dissociation

scholarly journals Activation pattern during his pacing: how close are we to normal physiology?

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
O Yasin ◽  
V Vaidya ◽  
J Tri ◽  
M Van Zyl ◽  
A Ladejobi ◽  
...  
Keyword(s):  
Sinus Rhythm ◽  
Left Ventricular ◽  
Conduction System ◽  
Funding Source ◽  
Activation Pattern ◽  
His Bundle ◽  
His Bundle Pacing ◽  
Surface Ecg ◽  
Qrs Duration ◽  
The Right

Abstract Background His bundle pacing aims to mimic the activation pattern of normal conduction to maintain ventricular synchrony. However, selective His capture can be challenging, and the activation sequence during His pacing may not replicate normal conduction. Purpose Compare the right ventricular (RV) and left ventricular (LV) activation pattern in sinus rhythm and His bundle pacing. Methods Baseline LV and RV map was created in sinus rhythm using Rhythmia mapping system (Boston Scientific Corporation) in canine animal model. Medtronic 3830 lead was placed near the bundle of His under fluoroscopic, intracardiac echocardiogram, and electroanatomic guidance. Conduction system capture was confirmed by observing a QRS duration <120ms and an isoelectric segment between pacing artifact and QRS on surface ECG. Repeat LV and RV activation map was obtained during His pacing. Average QRS, HV and pacing to V intervals were calculated with standard deviation. Results Mapping was performed successfully in four animals. At baseline, the average QRS duration was 44±2.6ms and HV interval was 32±4.2ms. Earliest site of myocardial activation was in the mid-septal LV region. The earliest RV myocardial activation was also at the septum closer to the apex, but later than the LV (Figure1A). With His pacing, the average QRS duration was 70±17.0ms and the average stim to V interval was 31±8.7ms. During His pacing, the earliest site of activation was in the RV septum, with an activation pattern from base to apex in both the RV and LV. Conclusion Unlike normal physiology, the activation pattern during conduction system pacing is from base to apex with earliest site in the RV. Funding Acknowledgement Type of funding source: Public hospital(s). Main funding source(s): Mayo Clinic

scholarly journals Electrode Model and Simulation of His- Bundle Pacing for Cardiac Resynchronization Therapy

2020 ◽  
Vol 6 (3) ◽  
pp. 555-558
Author(s):  
Domenic Pascual ◽  
Matthias Heinke ◽  
Reinhard Echle ◽  
Johannes Hörth
Keyword(s):  
Cardiac Resynchronization Therapy ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Left Ventricular Ejection ◽  
Resynchronization Therapy ◽  
Electrical Field ◽  
His Bundle ◽  
His Bundle Pacing ◽  
Surface Ecg ◽  
Electrical Pacing

AbstractA disturbed synchronization of the ventricular contraction can cause a highly developed systolic heart failure in affected patients with reduction of the left ventricular ejection fraction, which can often be explained by a diseased left bundle branch block (LBBB). If medication remains unresponsive, the concerned patients will be treated with a cardiac resynchronization therapy (CRT) system. The aim of this study was to integrate His-bundle pacing into the Offenburg heart rhythm model in order to visualize the electrical pacing field generated by His-Bundle-Pacing. Modelling and electrical field simulation activities were performed with the software CST (Computer Simulation Technology) from Dessault Systèms. CRT with biventricular pacing is to be achieved by an apical right ventricular electrode and an additional left ventricular electrode, which is floated into the coronary vein sinus. The non-responder rate of the CRT therapy is about one third of the CRT patients. His- Bundle-Pacing represents a physiological alternative to conventional cardiac pacing and cardiac resynchronization. An electrode implanted in the His-bundle emits a stronger electrical pacing field than the electrical pacing field of conventional cardiac pacemakers. The pacing of the Hisbundle was performed by the Medtronic Select Secure 3830 electrode with pacing voltage amplitudes of 3 V, 2 V and 1,5 V in combination with a pacing pulse duration of 1 ms. Compared to conventional pacemaker pacing, His-bundle pacing is capable of bridging LBBB conduction disorders in the left ventricle. The His-bundle pacing electrical field is able to spread via the physiological pathway in the right and left ventricles for CRT with a narrow QRS-complex in the surface ECG.

841Multi-center clinical experience with the usage of implantable pulse generators for permanent his bundle pacing

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
J Dinerman ◽  
P Deshmukh ◽  
J Qiao ◽  
W Li ◽  
J Mangual ◽  
...  
Keyword(s):  
Clinical Experience ◽  
Pulse Width ◽  
Cardiac Resynchronization ◽  
Safe Alternative ◽  
Pacemaker Therapy ◽  
His Bundle ◽  
His Bundle Pacing ◽  
Pulse Generators ◽  
Surface Ecg ◽  
Specific Device

Abstract Funding Acknowledgements Abbott Introduction His Bundle pacing (HBP) offers a more physiologic pacing approach to maintain electrical synchrony. Permanent HBP has emerged as a feasible and safe alternative to traditional pacemaker therapy and cardiac resynchronization therapy (CRT) with clinical and electrophysiological advantages. However, traditional implantable pulse generators (IPGs) have been used for HBP without supporting algorithms developed for HBP. Objective To assess a multi-center clinical experience with the usage of IPGs for permanent HBP and to identify the needs for HBP specific device algorithms. Methods Patients from 6 centers worldwide with a permanent HBP lead and an existing Abbott pacemaker, defibrillator, or CRT device were enrolled in this study. Device data and 12-lead surface ECG were collected simultaneously during device interrogation at a follow-up visit. HBP capture types at different pacing amplitudes were adjudicated using 12-lead ECG. Bundle branch block (BBB) correction by HBP was defined as QRS duration ≤130 ms or narrowing by >20%. Amplitudes of atrial and ventricular components on the HBP lead from both unipolar and bipolar sensing configurations were measured. Amplitudes of atrial component ≥ 0.5 mV on HB sensing EGMs were measured and considered as having risk of atrial oversensing. Results A total of 133 patients (75 ± 10 yrs, 92 male) were enrolled and completed study data collection post implant (median: 48, range: 0-3110 days). Patient characteristics, IPG type, and HBP lead connections were shown in the table. Dual-chamber pacemaker with HBP lead connected to V port was the most popular (65%) configuration. In non-BBB patients, pacing thresholds for selective HB (n = 44), non-selective HB (n = 54), and myocardial capture (n = 21) were 1.5 ± 1.2, 2.9 ± 2.0, 1.4 ± 1.5 V, respectively, at pulse width of 0.8 ± 0.4 ms. In BBB patients, LBBB and RBBB were corrected in 10/23 (43%) and 12/27 (44%) patients with pacing thresholds of 3.5 ± 2.4 and 2.1 ± 2.0 V, respectively, at pulse width of 0.8 ± 0.3 ms. AutoCapture™ algorithm was tested in 63 patients and recommended to be OFF in 28 (44%) patients. EGMs during intrinsic AV conduction were collected in 86 patients. A risk of atrial oversensing was identified in 24 (28%) and 27 (31%) patients during bipolar and unipolar sensing, respectively, and in 17 (20%) patients during both configurations. The average amplitude of the atrial and ventricular components on the HB lead EGM were 2.1 ± 2 and 6.0 ± 5.8 mV during bipolar sensing and 1.3 ± 1.2 and 6.3 ± 6.5 mV during unipolar sensing, respectively. Five (6%) patients had A/V amplitude ratios higher than 1. Conclusions Currently, various device configurations are used to overcome the fact that IPGs are not designed for HBP. Additionally, HBP presents unique challenges to ensure appropriate capture and sensing beyond traditional RV pacing. HBP specific device algorithms are needed to ensure correct IPG usage and facilitate device programming. Abstract Figure.

scholarly journals Overcoming left bundle branch block by permanent His bundle pacing: Evidence of longitudinal dissociation in the His via recordings from a permanent pacing lead

2017 ◽  
Vol 3 (11) ◽  
pp. 499-502 ◽  
Author(s):  
Parikshit S. Sharma ◽  
Kristin Ellison ◽  
Hena N. Patel ◽  
Richard G. Trohman
Keyword(s):  
Left Bundle Branch Block ◽  
Bundle Branch Block ◽  
His Bundle ◽  
His Bundle Pacing ◽  
Permanent Pacing ◽  
Pacing Lead ◽  
Longitudinal Dissociation

scholarly journals Electrocardiographic characterization of non-selective His bundle pacing. Validation of novel diagnostic criteria

2019 ◽  
Author(s):  
Marek Jastrzębski ◽  
Paweł Moskal ◽  
Karol Curila ◽  
Kamil Fijorek ◽  
Piotr Kukla ◽  
...  
Keyword(s):  
Sensitivity And Specificity ◽  
Left Ventricular ◽  
Peak Time ◽  
List Type ◽  
Intraventricular Conduction ◽  
His Bundle ◽  
His Bundle Pacing ◽  
Conduction Disturbances ◽  
Surface Ecg ◽  
Ecg Criteria

AbstractAimsPermanent His bundle (HB) pacing is usually accompanied by simultaneous capture of the adjacent right ventricular (RV) myocardium - this is described as a non-selective (ns)-HB pacing. Our aim was to identify ECG criteria for loss of HB capture during ns-HB pacing.MethodsConsecutive patients with permanent HB pacing were recruited. Surface 12-lead ECGs during ns-HB pacing and loss of HB capture (RV-only capture) were obtained. ECG criteria for loss/presence of HB capture were identified. In the validation phase these criteria and the “HB ECG algorithm” were tested by two blinded observers using a separate, sizable set of ECGs.ResultsA total of 353 ECG (226 ns-HB and 128 RV-only) were obtained from 226 patients with permanent HB pacing devices. QRS notch/slur in left ventricular leads and R-wave peak time in lead V6 were identified as the best features for differentiation. The 2-step HB ECG algorithm based on these features correctly classified 87.1% of cases with sensitivity and specificity of 93.2% and 83.9%, respectively. Moreover, the proposed criteria for definitive diagnosis of ns-HB capture (no QRS slur/notch in leads I, V1, V4-V6 and the R-wave peak time in V6 ≤ 100 ms) presented 100% specificity.ConclusionA novel ECG algorithm for the diagnosis of loss of HB capture and novel criteria for definitive confirmation of HB capture were formulated and validated. Practical application of these criteria during implant and follow-up of patients with HB pacing devices is feasible.Condensed AbstractThe 2-step ECG algorithm for loss of His bundle capture based on surface ECG analysis is proposed and validated. This method correctly classified 87.1% of cases with a sensitivity and specificity of 93.2% and 83.9%, respectively.What’s NewThis is the first study that analyzes QRS characteristics during non-selective His bundle pacing in a sizable cohort of patients.Precise criteria and a novel algorithm for electrocardiographic diagnosis of loss of HB capture during presumed non-selective HB pacing were validated.QRS notch/slur in left ventricular leads was identified as a simple and reproducible feature indicating loss of HB capture or lack/loss of correction of intraventricular conduction disturbances.Assessment of R-wave peak time in lead V6 rather than QRS duration for diagnosis of ns-HB pacing was validated.

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