Impact of His bundle pacing on right ventricular performance in patients undergoing permanent pacemaker implantation

Abstract

Background His‐Bundle pacing (HBP) is an emerging technique for physiological pacing. However, its effects on right ventricle (RV) performance are still unknown. Methods We enrolled consecutive patients with an indication for pacemaker (PM) implantation to compare HBP versus RV pacing (RVP) effects on RV performance. Patients were evaluated before implantation and after 6 months by a transthoracic echocardiogram. Results A total of 84 patients (age 75.1±7.9 years, 64% male) were enrolled, 42 patients (50%) underwent successful HBP, and 42 patients (50%) apical RVP. At follow up, we found a significant improvement in RV‐FAC (Fractional Area Change)% [baseline: HBP 34 IQR (31–37) vs. RVP 33 IQR (29.7–37.2),p = .602; 6‐months: HBP 37 IQR (33–39) vs. RVP 30 IQR (27.7–35), p < .0001] and RV‐GLS (Global Longitudinal Strain)% [baseline: HBP –18 IQR (–20.2 to –15) vs. RVP –16 IQR (–18.7 to –14), p = .150; 6‐months: HBP –20 IQR(–23 to –17) vs. RVP –13.5 IQR (–16 to –11), p < .0001] with HBP whereas RVP was associated with a significant decline in both parameters. RVP was also associated with a significant worsening of tricuspid annular plane systolic excursion (TAPSE) (p < .0001) and S wave velocity (p < .0001) at follow up. Conversely from RVP, HBP significantly improved pulmonary artery systolic pressure (PASP) [baseline: HBP 38 IQR (32–42) mmHg vs. RVP 34 IQR (31.5–37) mmHg,p = .060; 6‐months: HBP 32 IQR (26–38) mmHg vs. RVP 39 IQR (36–41) mmHg, p < .0001] and tricuspid regurgitation (p = .005) irrespectively from lead position above or below the tricuspid valve. Conclusions In patients undergoing PM implantation, HBP ensues a beneficial and protective impact on RV performance compared with RVP.

Evolution of tricuspid valve regurgitation after implantation of a leadless pacemaker: A single center experience, systematic review, and meta‐analysis

“…His‐Bundle pacing permits ventricular stimulation without crossing the tricuspid valve in some patients. Thanks to the more physiologic ventricular activation, His‐bundle and left bundle branch pacing may reduce the functional component and decrease TR 27,28 …”

Tricuspid regurgitation in His bundle pacing: A systematic review

“…We systematically assessed studies on HBP with an assessment of TR, which comprised of 9 original research articles and 1 case series reporting nearly 5 years of experience from 546 patients across centers around the world (Grieco et al, 2021 ; Hasumi et al, 2018 ; Hu et al, 2020 ; Hu et al, 2021 ; Huang et al, 2019 ; Ma et al, 2021 ; Shan et al, 2018 ; Vijayaraman et al, 2017 ; Wu et al, 2021 ; Ye et al, 2021 ). This is the first systematic analysis of a patient cohort to demonstrate the incidence of TR with HBP and its quantification before and after the procedural follow‐up, demonstrating its effects on ventricular synchrony.…”

“…HBP can also normalize conduction in patients with bundle branch block (BBB), hence, it has a role as an alternative to CRT (Abdelrahman et al, 2018 ). As HBP lead can be implanted above tricuspid annulus, its effect on TV morphology is minimal, leading to reversal of TR (Grieco et al, 2021 ; Hasumi et al, 2018 ; Hu et al, 2020 ; Hu et al, 2021 ; Huang et al, 2019 ; Ma et al, 2021 ; Shan et al, 2018 ; Vijayaraman et al, 2017 ; Wu et al, 2021 ; Ye et al, 2021 ). In this systematic review, we provide an association of TR in patients undergoing HBP.…”

His-Purkinje system pacing reduced tricuspid regurgitation in patients with persistent atrial fibrillation after left-sided valve surgery

“…These all suggested that ventricular electrical and mechanical dyssynchrony may be the key cause for TR, whether the electrodes cross the valve or not. Recently, Grieco et al (30) FIGURE 2 Comparison of tricuspid regurgitation velocity and cardiothoracic ratio before and after implantation of HPSP for 3 months. (A) Tricuspid regurgitation velocity significantly decreased after implantation of HPSP for 3 months.…”

“…These all suggested that ventricular electrical and mechanical dyssynchrony may be the key cause for TR, whether the electrodes cross the valve or not. Recently, Grieco et al ( 30 ) explored the influence of HBP and RVP on right heart function and found that compared with RVP, although some HBP electrodes crossed the tricuspid valve and were located under the valve, parameters of right heart function such as tricuspid regurgitation, PASP, TAPSE and RV-FAC were significantly improved at 6 months. A study using 3D echocardiography showed moderate-to-severe tricuspid regurgitation reduced to mild in patients after HBP, even though the electrodes crossed the tricuspid valve ( 31 ).…”