Cover Image
QR Code

Within‐patient comparison of His‐bundle pacing, right ventricular pacing, and right ventricular pacing avoidance algorithms in patients with PR prolongation: Acute hemodynamic study.

Aims: A prolonged PR interval may adversely affect ventricular filling and, therefore, cardiac function. AV delay can be corrected using right ventricular pacing (RVP), but this induces ventricular dyssynchrony, itself harmful. Therefore, in intermittent heart block, pacing avoidance algorithms are...

Full description

Published in:Journal of Cardiovascular Electrophysiology Vol. 31; no. 11; pp. 2964 - 2975
Main Authors: Keene, Daniel, Shun‐Shin, Matthew J., Arnold, Ahran D., March, Katherine, Qureshi, Norman, Ng, Fu Siong, Tanner, Mark, Linton, Nicholas, Lim, Phang B., Lefroy, David, Kanagaratnam, Prapa, Peters, Nicholas S., Francis, Darrel P., Whinnett, Zachary I.
Format: research tables/charts tracings Journal Article
Published: Wiley-Blackwell Nov2020
Online Access:View this record in EBSCOhost
fields @attributes:
  recordID: 1
pdfLink:
plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=146850902&site=ehost-live
header:
  @attributes:
    shortDbName: ccm
    uiTerm: 146850902
    longDbName: CINAHL Complete
    uiTag: AN
  controlInfo:
    bkinfo:
    dissinfo:
    jinfo:
      jid:
        10453873
        GSB
      jtl: Journal of Cardiovascular Electrophysiology
      issn: 10453873
      maglogo: Y
    pubinfo:
      dt: Nov2020
      vid: 31
      iid: 11
      pid: 480
      pub: Wiley-Blackwell
      place: Malden, Massachusetts
    artinfo:
      ui:
        146850902
        146235880
        146850902
        146850902
        10.1111/jce.14763
        146850902
      ppf: 2964
      ppct: 11
      formats:
        fmt:
          – @attributes:
              type: T
          – @attributes:
              type: C
          – @attributes:
              type: P
      tig:
        atl: Within‐patient comparison of His‐bundle pacing, right ventricular pacing, and right ventricular pacing avoidance algorithms in patients with PR prolongation: Acute hemodynamic study.
      aug:
        au:
          Keene, Daniel
          Shun‐Shin, Matthew J.
          Arnold, Ahran D.
          March, Katherine
          Qureshi, Norman
          Ng, Fu Siong
          Tanner, Mark
          Linton, Nicholas
          Lim, Phang B.
          Lefroy, David
          Kanagaratnam, Prapa
          Peters, Nicholas S.
          Francis, Darrel P.
          Whinnett, Zachary I.
        affil: National Heart and Lung Institute, Imperial College London, Hammersmith Hospital, London, UK
      sug:
        subj:
          Bundle of HIS Surgery
          Cardiac Pacing, Artificial
          Heart Ventricle, Right
          Algorithms
          Electrocardiography
          Human
          Hemodynamics
          Ventricular Ejection Fraction
          Descriptive Statistics
          Systolic Pressure
          Confidence Intervals
      ab: Aims: A prolonged PR interval may adversely affect ventricular filling and, therefore, cardiac function. AV delay can be corrected using right ventricular pacing (RVP), but this induces ventricular dyssynchrony, itself harmful. Therefore, in intermittent heart block, pacing avoidance algorithms are often implemented. We tested His‐bundle pacing (HBP) as an alternative. Methods: Outpatients with a long PR interval (>200 ms) and intermittent need for ventricular pacing were recruited. We measured within‐patient differences in high‐precision hemodynamics between AV‐optimized RVP and HBP, as well as a pacing avoidance algorithm (Managed Ventricular Pacing [MVP]). Results: We recruited 18 patients. Mean left ventricular ejection fraction was 44.3 ± 9%. Mean intrinsic PR interval was 266 ± 42 ms and QRS duration was 123 ± 29 ms. RVP lengthened QRS duration (+54 ms, 95% CI 42–67 ms, p <.0001) while HBP delivered a shorter QRS duration than RVP (−56 ms, 95% CI −67 to −46 ms, p <.0001). HBP did not increase QRS duration (−2 ms, 95% CI −8 to 13 ms, p =.6). HBP improved acute systolic blood pressure by mean of 5.0 mmHg (95% CI 2.8–7.1 mmHg, p <.0001) compared to RVP and by 3.5 mmHg (95% CI 1.9–5.0 mmHg, p =.0002) compared to the pacing avoidance algorithm. There was no significant difference in hemodynamics between RVP and ventricular pacing avoidance (p =.055). Conclusions: HBP provides better acute cardiac function than pacing avoidance algorithms and RVP, in patients with prolonged PR intervals. HBP allows normalization of prolonged AV delays (unlike pacing avoidance) and does not cause ventricular dyssynchrony (unlike RVP). Clinical trials may be justified to assess whether these acute improvements translate into longer term clinical benefits in patients with bradycardia indications for pacing.
      pubtype: Academic Journal
      doctype:
        research
        tables/charts
        tracings
        Journal Article
      ougenre: Article
    language: English
    refInfo:
    holdings:
      @attributes:
        islocal: N