Comparison of the effects of selective and non-selective His bundle pacing on cardiac electrical and mechanical synchrony

Zhang, Jinlong; Guo, Jianghong; Hou, Xiaofeng; Wang, Yao; Zhang, Qian; Li, Kebei; Ge, Peibing; Zou, Jiangang

doi:10.1093/europace/eux120

Cited by 80 publications

(61 citation statements)

References 22 publications

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“…Although limited studies support the concept that nonselective HB pacing is hemodynamically equivalent to selective pacing, 32,33 we do not have concrete clinical evidence. Selective HB pacing is certainly closer to physiology and offers a straightforward electrocardiographic diagnosis of the presence/loss of HB capture and also allows to easily offset the HV interval from atrioventricular delay during DDD pacing.…”

Section: Selective Vs Nonselective Hb Capturementioning

confidence: 80%

His bundle has a shorter chronaxie than does the adjacent ventricular myocardium: Implications for pacemaker programming

et al. 2019

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BACKGROUND Strength-duration curves for permanent His bundle (HB) pacing are potentially important for pacemaker programming.OBJECTIVES We aimed to calculate strength-duration curves and chronaxies of the HB and of the adjacent right ventricular (RV) working myocardium and to analyze zones of selective HB capture and battery current drain when pacing at different pulse durations (PDs).METHODS Consecutive patients with permanent HB pacing were studied. The RV and HB capture thresholds were assessed at several PDs. Battery current drain and zones of selective HB capture at PDs of 0.1, 0.2, 0.4, and 1.0 ms were determined. RESULTSIn the whole group (N 5 127), the HB chronaxie was shorter than the RV chronaxie. This difference was driven by patients with selective HB pacing (HB chronaxie 0.47 ms vs RV chronaxie 0.79 ms). The strength-duration curve for the HB had a lower rheobase and its steep portion started at shorter PDs, thus creating wider distance-zone of programmable selective HB pacing-between the HB and RV strength-duration curves at shorter PDs. The battery current drain was lower with pacing at PDs of 0.1-0.4 ms vs 1.0 ms. Chronaxie-adjusted PDs offered the lowest current drain.CONCLUSION For the first time, the strength-duration curves for permanent selective and nonselective HB pacing were determined. Selective HB capture and battery longevity can be promoted by shorter PDs (0.2 ms). Longer PDs (1.0 ms) offer greater safety margin for RV capture and may be preferable if simultaneous RV capture during HB pacing is desired.

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Section: Selective Vs Nonselective Hb Capturementioning

confidence: 80%

His bundle has a shorter chronaxie than does the adjacent ventricular myocardium: Implications for pacemaker programming

et al. 2019

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“…A study by Fozzard and Schoenberg concerning His bundle chronaxie assessed in the milieu of experimental ex vivo models reported chronaxie values of approximately 0.23 ms 27. Selective vs non-selective HB captureAlthough limited studies support the concept that non-selective HB pacing is hemodynamically equivalent to selective pacing,28,29 we do not have concrete clinical evidence. Selective HB pacing is certainly closer to physiology and offers straightforward ECG diagnosis of presence/loss of HB capture and also allows to easily offset HV interval from atrioventricular delay during DDD pacing.…”

mentioning

confidence: 89%

His bundle has shorter chronaxie than adjacent ventricular myocardium: Implications for pacemaker programming

Jastrzębski

Moskal

Bednarek

et al. 2019

Preprint

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Background: Strength-duration curves for permanent His bundle (HB) pacing are potentially important for pacemaker programming.Objective: We aimed to calculate strength-duration curve and chronaxie of the His bundle (HB) and of the adjacent right ventricular (RV) working myocardium and to analyze zones of selective HB capture and battery current drain when pacing at different pulse durations (PDs). Methods:Consecutive patients with permanent HB pacing were studied. The RV and HB capture thresholds were assessed at several PDs. Battery current drain and zones of selective HB capture at PDs of 0.1, 0.2, 0.4 and 1.0 ms were determined. Results:In the whole group (n =127) the HB chronaxie was shorter than the RV chronaxie. This difference was driven by patients with selective HB pacing (HB chronaxie of 0.47 vs RV chronaxie of 0.79 ms). Strength-duration curve for HB had lower rheobase and its steep portion started at shorter PDs thus creating wider distance -zone of programmable selective HB pacing -between the HB and RV strength-duration curves at shorter PDs. The battery current drain was lower with pacing at PDs of 0.1 -0.4 ms vs 1.0 ms. Chronaxie adjusted PDs offered lowest current drain. Conclusion: For the first time the strength-duration curves for permanent selective and nonselective HB pacing were determined. Selective HB capture and battery longevity can be promoted by shorter PDs (0.2 ms). Longer PDs (1.0 ms) offer bigger safety margin for RV capture and may be preferable if simultaneous RV capture during HB pacing is desired.

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“…In 2000, the utility of HBP was first reported in patients with atrial fibrillation (AF) and cardiomyopathy undergoing atrioventricular (AV) node ablation and left ventricular (LV) function was shown to improve after HBP . Recent studies and meta‐analyses have demonstrated the superiority of HBP in preserving electrical synchrony and LV function compared to conventional right ventricular pacing . Currently, cardiac resynchronization therapy (CRT) is the standard‐of‐care therapy for the patients with heart failure and LV dyssynchrony.…”

Section: Introductionmentioning

confidence: 99%

“…1 Recent studies and meta-analyses have demonstrated the superiority of HBP in preserving electrical synchrony and LV function compared to conventional right ventricular pacing. [2][3][4][5] Currently, cardiac resynchronization therapy (CRT) is the standard-of-care therapy for the patients with heart failure and LV dyssynchrony. However, approximately 30% of the patients show no response.…”

Section: Introductionmentioning

confidence: 99%

Permanent His bundle pacing in heart failure patients: A systematic review and meta‐analysis

Zhang

Zou

Wang

et al. 2018

Pacing Clinical Electrophis

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Background Cardiac resynchronization therapy (CRT) is the standard‐of‐care therapy for the patients with heart failure and left ventricular (LV) dyssynchrony. However, approximately 30% of the patients show no response. Recent studies have shown that His bundle pacing (HBP) could be an alternative for the patients with CRT indications. The purpose of this study was to evaluate the efficacy of HBP in patients with heart failure. Methods We searched PubMed and Embase databases for studies evaluating HBP in patients with heart failure and LV dyssynchrony. The successful rate of implantation, QRS duration, pacing threshold, LV function at baseline and follow‐up, and mortality rates were extracted and summarized. Results Eleven studies including 494 patients were included in this analysis. The overall successful rate for implantation was 82.4%. The main indications for HBP were CRT candidates and cardiomyopathy with atrial fibrillation undergoing atrioventricular node ablation. Permanent HBP resulted in narrow QRS duration of 116.3 ± 13.9 ms after implantation. LV functions, including echocardiographic parameters and clinical outcomes, significantly improved at follow‐up (P < 0.001). However, there was a trend of increased capture and bundle branch block correction thresholds at follow‐up compared to baseline (P = 0.01 and 0.02, respectively). During a mean follow‐up of 23.7 months, 5.9% of the patients experienced heart failure‐related hospitalization and the mortality rate was 9.1%. Conclusion Permanent HBP has shown promising results for heart failure patients in small observational studies. Randomized controlled trials are needed to assess the efficacy of HBP in these patients.

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Comparison of the effects of selective and non-selective His bundle pacing on cardiac electrical and mechanical synchrony

Abstract: Selective His bundle pacing and high-output NS-HBP could restore normal electrical and LV mechanical synchrony.

Cited by 80 publications

References 22 publications

His bundle has a shorter chronaxie than does the adjacent ventricular myocardium: Implications for pacemaker programming

His bundle has a shorter chronaxie than does the adjacent ventricular myocardium: Implications for pacemaker programming

His bundle has shorter chronaxie than adjacent ventricular myocardium: Implications for pacemaker programming

Permanent His bundle pacing in heart failure patients: A systematic review and meta‐analysis

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