Effects of Rhythm and Rate-Controlling Drugs in Patients With Permanent His-Bundle Pacing

Abstract

Introduction: Antiarrhythmic drug therapy can affect pacemaker parameters in both the atrial and ventricular myocardium. It is not known whether antiarrhythmic drugs impact His bundle pacing/sensing parameters and His to ventricle (H-V) intervals following permanent His bundle pacing (HBP). The aims of the study were to prospectively determine the influence of rhythm and rate-controlling drugs on pacing parameters and H-V conduction after His bundle lead implantation and to assess the impact of rhythm and rate-controlling drugs on the safety of HBP.Materials and Methods: Patients (N = 140) with QRS duration < 120 ms who met permanent pacing indications were prospectively enrolled. Propafenone, lidocaine, and adenosine were injected intravenously after implantation of 3,830 lead during the procedure. Metoprolol succinate, amiodarone, and digoxin were taken orally for 1 month. Pacing parameters before and after drug intervention was measured, including His capture threshold, sensing and impedance, H-V interval, and conduction.Results: There were no statistically significant differences in His bundle pacing thresholds, impedance, and sensing after drug intervention at implantation or during a 2-month follow-up (P > 0.05). The HV interval was not affected except in the large-dose propafenone group where HV interval prolonged (P = 0.001). All patients maintained 1:1 H-V conduction following drug administration.Conclusion: There was no adverse impact on the HBP parameters or H-V conduction after the administration of commonly used dosage of rhythm and rate-controlling drugs. The drugs were safe in patients with permanent His bundle pacing.

A method for noninvasive beat‐by‐beat visualization of His bundle signals

“…It should be admitted that the proposed method has some limita- the visualization of HBS in inter-beat contour as shown in this work could still be acceptable for needy cases where continuous tracking of HBS is expected to be informative like for example, in studying the influence of pharmacological interventions (Su et al, 2020) and follow-up measurements where a conventional EPS recording involving fluoroscopic radiation may not be advisable (Muresan et al, 2019). There are ample scopes for refinements on the proposed method with respect to the automation of the IDWT process for fixing thresholds settings and adapting the methodology to encounter arrhythmic beats etc.…”

Effects of coronary artery disease in patients with permanent left bundle branch area pacing: A retrospective study

“…Consequently, while the pacemaker itself may function normally, the capture threshold might elevate, possibly leading to ineffective capture of the myocardium and the induction of depolarization [ 36 , 53 ]. Notably, the effect of AADs on the capture threshold remained controversial due to contradicting reports [ 7 , [54] , [55] , [56] , [57] ]. This study also identified no significant association between AADs and capture threshold, which might be because LBBaP beyond the site of the block and AADs had no impact on the conduction beneath the his-bundle lead.…”

Pharmacotherapy in Ventricular Arrhythmias

“…Flecainide increases the sinus node recovery time and delays intra-atrial and atrioventricular conduction, thus increasing the PR, QRS, and QT intervals without an increase in QTc duration [15]. It may cause an increase in the pacing threshold; however, no adverse impact has been noted in patients with pacemakers including those utilizing conduction system pacing [16, 17].…”