Physiological mechanisms of QRS narrowing in bundle branch block patients undergoing permanent His bundle pacing

Teng, Alexandra; Massoud, Louis; Ajijola, Olujimi A.

doi:10.1016/j.jelectrocard.2016.07.013

Cited by 38 publications

(26 citation statements)

References 23 publications

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“…According to the theory of longitudinal dissociation, fibers within the His bundle are predestined to the left or right bundle branches and bundle branch block may occur within the His bundle. 7 If the HBP lead tip is placed proximal to the LBBB region, a higher pacing output than the capture threshold of HBP is needed to correct LBBB. 7,8 Our results of HBP are consistent with this hypothesis; for example, a higher pacing output than the capture threshold was needed for HBP to correct LBBB.…”

Section: Discussionmentioning

confidence: 99%

“…7 If the HBP lead tip is placed proximal to the LBBB region, a higher pacing output than the capture threshold of HBP is needed to correct LBBB. 7,8 Our results of HBP are consistent with this hypothesis; for example, a higher pacing output than the capture threshold was needed for HBP to correct LBBB. Since LBBP at the capture threshold could directly correct LBBB, the pacing tip must be distal to the LBBB region.…”

Section: Discussionmentioning

confidence: 99%

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A comparison of left bundle branch pacing with His bundle pacing in a patient with heart failure and left bundle branch block

Lin

Dai

Wang

et al. 2020

HeartRhythm Case Reports

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

A comparison of left bundle branch pacing with His bundle pacing in a patient with heart failure and left bundle branch block

Lin

Dai

Wang

et al. 2020

HeartRhythm Case Reports

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“…Considering the equal efficacy of implantable cardioverter defibrillator (ICD) electrode positioned to either septum or apex [ 46 – 48 ], leads of HBRP and ICD could be then integrated. Furthermore, QRS duration in some patients with LBBB wasn’t shortened by HBRP because of infra-His bundle block close to branch bundles [ 17 , 49 ], and hence, distal His bundle pacing should be preferred for fear of His bundle block in proximal and medial sites.…”

Section: Discussionmentioning

confidence: 99%

Integrative and quantitive evaluation of the efficacy of his bundle related pacing in comparison with conventional right ventricular pacing: a meta-analysis

Chen

et al. 2017

BMC Cardiovasc Disord

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BackgroundLong-term RVP could bring adverse problems to cardiac electro-mechanics and result in inter- and intra-ventricular asynchrony, impaired labor force, and aggravation of cardiac function. HBRP including direct His bundle pacing and para-His bundle pacing was regarded as a novel physiological pacing pattern to avoid devastating cardiac function. This synthetic study was conducted to integratively and quantitatively evaluate the efficacy of His bundle related pacing (HBRP) in comparison with conventional right ventricular pacing (RVP).MethodsPublished studies on comparison of left ventricular ejection fraction (LVEF), left ventricular end diastolic volume (LVEDV), left ventricular end systolic volume (LVESV), New York Heart Association (NYHA) class, inter-ventricular asynchrony, and QRS duration, etc. between HBRP and RVP were collected and for meta-analysis.ResultsHBRP showed higher LVEF (WMD = 3.9%, 95% CI: 1.6% – 6.1%), lower NYHA class (WMD = −0.5, 95% CI: -0.7 – -0.3), WMD of LVESV = −0.1 ml, 95% CI: -3.0 – 2.8 ml), less inter-ventricular asynchrony (WMD = −13.2 ms, 95% CI: -16.4 – -10.0 ms), and shorter QRS duration for long-term (WMD = −36.9 ms, 95% CI: -40.0 – -33.8 ms), however, no significant difference of ventricular volume (WMDLVEDV = −2.4 ml, 95% CI: -5.0 – 0.2 ml; WMDLVESV = −0.1 ml, 95% CI: -3.0 – 2.8 ml) compared to RVP.ConclusionsThe efficacy of HBRP was firstly verified by meta-analysis to date. Compared with RVP, HBRP markedly preserve LVEF, NYHA class, and QRS duration. However, it seemed to have less effect on ventricular volume.Electronic supplementary materialThe online version of this article (doi:10.1186/s12872-017-0649-4) contains supplementary material, which is available to authorized users.

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“…Our electrophysiological investigation results are consistent with this histological finding. Furthermore, we may apply the concept of longitudinal dissociation, which means that the fibers within the His bundle are predestined for the left or right bundle branches, to this anatomical characteristic; that is, the fibers predestined for FV pathways originating within the proximal His bundle extend into the FV pathways similar to the left or right bundle branches (Figure B). This concept has been recently supported particularly with respect to His bundle pacing, but some papers raised concern regarding the longitudinal dissociation theory itself .…”

Section: Discussionmentioning

confidence: 99%

Fasciculoventricular pathway connecting to the left posterior fascicle area throughout the slow pathway with longitudinal dissociation in the His bundle

Inagaki

Moriyama

Fukamizu

et al. 2019

Cardiovasc electrophysiol

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Keywords double ventricular response, dual atrioventricular nodal pathway, fasciculoventricular pathway, left posterior fascicle, longitudinal dissociation, pre-excitation syndrome 1 | CASE REPORT A 47-year-old man presented to our hospital for catheter ablation for paroxysmal supraventricular tachycardia. Twelve-lead electrocardiography (ECG) revealed sinus rhythm and right axis deviation with a heart rate of 70 beats per min and showed an episode of short RP (the interval between the R wave and the P wave of the ECG), narrow QRS (the QRS complex of the ECG) regular tachycardia with a heart rate of 170 beats per min. After obtaining written informed consent, a cardiac electrophysiological study was conducted. Multielectrode catheters were placed at the high right atrium, His bundle, coronary sinus (CS), and right ventricular apex. Tachycardia (cycle length: 400 ms) was reproducibly induced by right atrial electrical stimulus (Figure 1). The earliest atrial activation was observed at the CS distal electrode. The sequence of atrial activation during ventricular pacing was the same as that during tachycardia. The delivery of a single Hisrefractory ventricular extra stimulus during tachycardia revealed the advancement of atrial activation without a change in atrial activation. Based on these findings, orthodromic atrioventricular (AV) re-entrant tachycardia with a left lateral Kent bundle was diagnosed. Radiofrequency energy was delivered to the left lateral Kent bundle during ventricular pacing, and the ventriculoatrial conduction with the accessory pathway was blocked 3.7 seconds after starting ablation. During programmed atrial stimulation at progressively shorter coupling intervals (basic cycle length: 600 ms) after ablation, double ventricular response (DVR) was observed (Figure 2A). This phenomenon was observed at coupling intervals between 460 and 230 ms, which was the effective atrial refractory period. The second ventricular response (V3), which was activated via the slow pathway, showed wide QRS with right bundle branch block and left axis deviation ( Figure 2B) and the H3V3 intervals were maintained at 25 ms. Conversely, the first ventricular response (V2), which was activated via the fast pathway, showed normal narrow QRS and the H2V2 intervals were 45 ms. The short H3V3 intervals were constant despite the prolongation of A2H3 intervals with shorter coupling intervals. This indicated the existence of the fasciculoventricular (FV) pathway connecting to the left posterior fascicle (LPF) area. This conduction pathway was not observed at activation via the fast pathway; therefore, we considered that the FV pathway connected to the LPF area throughout the slow pathway with longitudinal dissociation in the His bundle during DVR using the dual AV nodal pathway ( Figure 3A).The FV pathway reportedly does not participate in tachycardia, so we did not perform additional ablation targeting this pathway. No arrhythmia was induced by programmed stimulus thereafter, and the patient had no recurrence of tachycardia dur...

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Physiological mechanisms of QRS narrowing in bundle branch block patients undergoing permanent His bundle pacing

Cited by 38 publications

References 23 publications

A comparison of left bundle branch pacing with His bundle pacing in a patient with heart failure and left bundle branch block

A comparison of left bundle branch pacing with His bundle pacing in a patient with heart failure and left bundle branch block

Integrative and quantitive evaluation of the efficacy of his bundle related pacing in comparison with conventional right ventricular pacing: a meta-analysis

Fasciculoventricular pathway connecting to the left posterior fascicle area throughout the slow pathway with longitudinal dissociation in the His bundle

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