His or para-His pacing preserves left ventricular function in atrioventricular block: a double-blind, randomized, crossover study

Kronborg, Mads Brix; Mortensen, Peter Thomas; Poulsen, Steen Hvitfeldt; Gerdes, Jens Christian; Jensen, Henrik Kjærulf; Nielsen, Jens Cosedis

doi:10.1093/europace/euu011

Cited by 154 publications

(114 citation statements)

References 25 publications

Supporting

Mentioning

108

Contrasting

Unclassified

Order By: Relevance

“…Acute lead dislodgment is uncommon but a significant increase in threshold has been reported in up to 5% of cases postimplant requiring lead revision . Initially success rates of capturing the true HB were of the order of 80 to 85% but more recent improvements in leads and delivery systems and in implanter experience have increased this to in excess of 90% …”

Section: His Bundle Pacingmentioning

confidence: 99%

The desire for physiological pacing: Are we there yet?

Kaye

2019

Cardiovasc electrophysiol

View full text Add to dashboard Cite

Pacing is a well established therapy for bradycardia support and certain types of heart failure. Despite technological advances the optimal pacing lead position remains controversial. Right ventricular pacing, particularly apical has been the site of choice but the induction of abnormal cardiac depolarization and the recognition of an increased risk of impairment of left ventricular systolic function, heart failure and mortality has driven a desire for a true physiological pacing system. A number of different lead positions have been determined and of these His bundle pacing appears to most closely mimic normal ventricular conduction. This article reviews the background to the development of physiological pacing, evaluates historical data for right ventricular pacing and the basis for change and new lead positions.

show abstract

Section: His Bundle Pacingmentioning

confidence: 99%

The desire for physiological pacing: Are we there yet?

Kaye

2019

Cardiovasc electrophysiol

View full text Add to dashboard Cite

show abstract

“…Hisian (pacing the His Bundle) and Para-hisian (pacing the myocardium around the His bundle) pacing although restores the normal electrical activation pattern, it is technically difficult and has problems with higher pacing thresholds. 16,17 RVOT pacing has been studied and compared with RVA pacing in multiple trials with most of them favoring non-apical pacing sites. A metaanalysis of 14 randomized controlled trials with more than 700 patients showed higher left ventricular ejection fraction (LVEF) with non-apical pacing site.…”

Section: Why Rv Apical Pacing Is Deleterious To Cardiac Function?mentioning

confidence: 99%

Location! The unanswered question in right ventricular pacing

Kumar

2015

Journal of Nuclear Cardiology

View full text Add to dashboard Cite

See related article, pp. 903-911Location, like in real estate, is the most important question in electrophysiology as it determines the acute and long-term outcomes in patients undergoing ablation as well as placement of pacing or high voltage leads. Right ventricular (RV) apex is the most commonly selected location for placement of RV pacing leads. This preference reflects the ease, stability, and excellent pacing thresholds usually achieved at this location. However, human and experimental data have suggested potential deleterious effects of RV pacing on cardiac function, and thus, there has been an interest in alternate RV pacing sites. Singh et al in this issue of the journal present their study comparing right ventricular outflow tract (RVOT) and RV apical pacing using equilibrium radionuclide angiography (ERNA). To better understand and review the findings of their study or any trial of alternate site RV pacing, we must first answer the following questions. WHY RV APICAL PACING IS DELETERIOUS TO CARDIAC FUNCTION?RV apical pacing leads to iatrogenic left bundle branch block (LBBB) resulting in altered left ventricular activation pattern. To appreciate why this is deleterious to left ventricle (LV) performance, we should contrast it with normal LV endocardial activation. In normal hearts with intact conduction system, LV endocardial activation occurs 0-15 ms after the onset of QRS almost simultaneously in two areas: the mid septum and the anterobasal wall. From here, it spreads briskly with total endocardial activation time of 30-50 ms, which results in synchronous mechanical contraction of all areas in the LV.1 In pacing-induced LBBB, the activation has to spread from right to left across the septum, which is slow, resulting in earliest LV endocardial activation around 50 ms after the onset of QRS and hence interventricular dyssynchrony. From here, the activation spreads across the rest of the LV with total endocardial activation time around 80-90 ms. This time can be exaggerated in patients with underlying cardiomyopathy or previous infarction as reflected by markedly longer paced QRS duration in these patients resulting in significant intraventricular dyssynchrony. The inter-and intraventricular dyssynchrony from RV pacing results in acute decrease in cardiac pump function as shown by a decrease in the maximum dp/dt, mean arterial pressure, stroke volume, and stroke work and an increase in isovolumetric contraction and relaxation times in both animal and human studies.2-4 The pressure volume relationship of the LV shifts rightward and it operates at a higher volume. Dyssynchrony in activation and subsequent contraction of the LV leads to heterogeneity of stretch and loading conditions in pacing-induced or native LBBB. This can cause regional changes in myocardial perfusion as seen by perfusion defects and wall motion abnormalities in many of these patients with angiographically normal coronary arteries. [5][6][7] These acute changes in LV performance when present over a long duration can lead to asymmetri...

show abstract

“…Some data from acute or short-term randomized studies support this hypothesis. [34][35][36][37] Most studies have used LVEF as a surrogate of clinical outcomes. The majority of studies have reported a preservation of LVEF with alternate site RV pacing when compared with reduced LVEF in those randomized to RV apical pacing.…”

Section: Alternative Rv Pacing Sitesmentioning

confidence: 99%

“…Although promising, pacing from sites in the His bundle region remains problematic with lower success rates, higher pacing thresholds, and longer procedure times. 35,37 Alternative RV pacing sites have not yet been shown to reduce significant cardiovascular events, such as AF or HF. One additional randomized clinical trial comparing septal locations with RV apical pacing is completing follow-up and when reported may provide valuable additional insights as to the clinical value of these alternate pacing sites.…”

Section: Alternative Rv Pacing Sitesmentioning

confidence: 99%