Left ventricular activation time and pattern are preserved with both selective and nonselective His bundle pacing

• Published in: Heart rhythm O2 Vol. 2; no. 5; pp. 439 - 445
• Main Authors: Arnold, Ahran D., Shun-Shin, Matthew J., Ali, Nadine, Keene, Daniel, Howard, James P., Chow, Ji-Jian, Qureshi, Norman A., Koa-Wing, Michael, Tanner, Mark, Lefroy, David C., Linton, Nick W.F., Ng, Fu Siong, Lim, Phang Boon, Peters, Nicholas S., Kanagaratnam, Prapa, Francis, Darrel P., Whinnett, Zachary I.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.10.2021; Elsevier
• Subjects: Cardiovascular; Clinical; Conduction system pacing; ECG; Electrocardiographic imaging; His bundle pacing; Pacing; Selective His bundle pacing; ECG; Pacing; His bundle pacing; Selective His bundle pacing; Conduction system pacing; Electrocardiographic imaging
• ISSN: 2666-5018; 2666-5018
• DOI: 10.1016/j.hroo.2021.08.001

His bundle pacing (HBP) can be achieved in 2 ways: selective HBP (S-HBP), where the His bundle is captured alone, and nonselective HBP (NS-HBP), where local myocardium is also captured, resulting a pre-excited electrocardiogram appearance. We assessed the impact of this ventricular pre-excitation on left and right ventricular dyssynchrony. We recruited patients who displayed both S-HBP and NS-HBP. We performed noninvasive epicardial electrical mapping for left and right ventricular activation time (LVAT and RVAT) and pattern. Twenty patients were recruited. In the primary analysis, the mean within-patient change in LVAT from S-HBP to NS-HBP was -5.5 ms (95% confidence interval: -0.6 to -10.4, noninferiority P < .0001). NS-HBP did not prolong RVAT (4.3 ms, -4.0 to 12.8, P = .296) but did prolong QRS duration (QRSd, 22.1 ms, 11.8 to 32.4, P = .0003). In patients with narrow intrinsic QRS (n = 6), NS-HBP preserved LVAT (-2.9 ms, -9.7 to 4.0, P = .331) but prolonged QRS duration (31.4 ms, 22.0 to 40.7, P = .0003) and mean RVAT (16.8 ms, -5.3 to 38.9, P = .108) compared to S-HBP. Activation pattern of the left ventricular surface was unchanged between S-HBP and NS-HBP, but NS-HBP produced early basal right ventricular activation that was not seen in S-HBP. Compared to S-HBP, local myocardial capture during NS-HBP produces pre-excitation of the basal right ventricle resulting in QRS duration prolongation. However, NS-HBP preserves the left ventricular activation time and pattern of S-HBP. Left ventricular dyssynchrony is not an important factor when choosing between S-HBP and NS-HBP in most patients. [Display omitted]