Right ventricular septal pacing in patients with right bundle branch block

Giudici, Michael; Abu-El-Haija, Basil; Schrumpf, Phillip E.; Bhave, Prashant D.; Khiami, Belal Al; Barold, S. Serge

doi:10.1016/j.jelectrocard.2015.04.018

Cited by 7 publications

(5 citation statements)

References 13 publications

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“…In patients with RBBB, right ventricular septal pacing can shorten QRS duration and this pacing modality achieved electrical resynchronization and improved LVEF and HF symptoms in a study of patients with HFrEF and isolated RBBB. 28,29 We found that 16% of patients developed new-onset QRS widening to ≥130 ms over a median follow-up of 2.5 years (6.1 per 100 patient-years). Incident LBBB occurred in 6.3% of patients (2.4 per 100 patient-years).…”

Section: Discussionmentioning

confidence: 86%

“…His bundle pacing might be such an approach, although this needs to be tested in appropriately designed prospective clinical trials. In patients with RBBB, right ventricular septal pacing can shorten QRS duration and this pacing modality achieved electrical resynchronization and improved LVEF and HF symptoms in a study of patients with HFrEF and isolated RBBB 28,29 …”

Section: Discussionmentioning

confidence: 99%

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Prevalence and incidence of intra‐ventricular conduction delays and outcomes in patients with heart failure and reduced ejection fraction: insights from PARADIGM‐HF and ATMOSPHERE

Kristensen

Castagno

Shen

et al. 2020

European J of Heart Fail

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Aims The importance of intra‐ventricular conduction delay (IVCD), the incidence of new IVCD and its relationship to outcomes in heart failure and reduced ejection fraction (HFrEF) are not well studied. We addressed these questions in the PARADIGM‐HF and ATMOSPHERE trials. Methods and results The risk of the primary composite outcome of cardiovascular death or heart failure hospitalization and all‐cause mortality were estimated by use of Cox regression according to baseline QRS duration and morphology in 11 861 patients without an intracardiac device. At baseline, 1789 (15.1%) patients had left bundle branch block (LBBB), 524 (4.4%) right bundle branch block (RBBB), 454 (3.8%) non‐specific IVCD, 2588 (21.8%) ‘mildly abnormal’ QRS (110–129 ms) and 6506 (54.9%) QRS <110 ms. During a median follow‐up of 2.5 years, the risk of the primary composite endpoint was higher among those with a wide QRS, irrespective of morphology: hazard ratios (95% confidence interval) LBBB 1.36 (1.23–1.50), RBBB 1.54 (1.31–1.79), non‐specific IVCD 1.65 (1.40–1.94) and QRS 110–129 ms 1.35 (1.23–1.47), compared with QRS duration <110 ms. A total of 1234 (15.6%) patients developed new‐onset QRS widening ≥130 ms (6.1 per 100 patient‐years). Incident LBBB occurred in 495 (6.3%) patients (2.4 per 100 patient‐years) and was associated with a higher risk of the primary composite outcome [hazard ratio 1.42 (1.12–1.82)]. Conclusion In patients with HFrEF, a wide QRS was associated with worse clinical outcomes irrespective of morphology. The annual incidence of new‐onset LBBB was around 2.5%, and associated with a higher risk of adverse outcomes, highlighting the importance of repeat electrocardiogram review. Trial Registration: ClinicalTrials.gov Identifier NCT0083658 (ATMOSPHERE) and NCT01035255 (PARADIGM‐HF).

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Section: Discussionmentioning

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Prevalence and incidence of intra‐ventricular conduction delays and outcomes in patients with heart failure and reduced ejection fraction: insights from PARADIGM‐HF and ATMOSPHERE

Kristensen

Castagno

Shen

et al. 2020

European J of Heart Fail

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“…Recent reports, however, support our finding that some of these patients may benefit from a dual‐chamber pacing device. Significant narrowing of the QRS complex and reduction in clinical effects have been reported when investigators programed AV delays to provide optimal fusion between right ventricular septal pacing and LV conduction . Siliste et al.…”

Section: Discussionmentioning

confidence: 58%

The electromechanical substrate for response to cardiac resynchronization therapy in patients with right bundle branch block

Atwater

Wagner

Kisslo

et al. 2017

Pacing Clinical Electrophis

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“…The optimal pacing method for bradyarrhythmia with RBBB remains to be explored. His-Bundle pacing, cardiac resynchronization therapy, and right bundle-branch pacing can correct RBBB morphology, but it has the disadvantages of complicated operation process, unstable pacing threshold, and low success rate [9][10][11]. At present, LBBAP is a physiological pacing method with high success rate, stable pacing threshold for bradyarrhythmia.…”

Section: Discussionmentioning

confidence: 99%

Early assessment of ventricular synchronization and function after left bundle-branch-area pacing with right bundle-branch block

Zhao

Xiong

Deng

et al. 2022

BMC Cardiovasc Disord

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Aim To evaluate ventricular synchronization and function in patients with right bundle-branch block after left bundle-branch-area pacing (LBBAP) by echocardiography. Methods Forty patients who successfully received LBBAP were selected and divided into the right bundle-branch block group (RBBB group) and the non-RBBB group by pre-operation ECG. Echocardiography and follow-up were performed 1 month after operation. Interventricular synchronization was evaluated by tissue Doppler (TDI), tissue mitral annular displacement (TMAD), and interventricular mechanical delay. The tricuspid annular plane systolic excursion (TAPSE), right ventricular fractional area change (RVFAC), tricuspid annulus sidewall systolic velocity (TV-s’), left ventricular global ventricular longitudinal strain (GLS), right ventricular free wall longitudinal strain (LS-RV), standard deviation of left ventricular 18 segments peak time difference (SDt-L) and standard deviation of right ventricular free wall 3 segments peak time difference (SDt-R) were applied to evaluate intraventricular synchronization and ventricular function. Results The difference of displacement peak time of the tricuspid and mitral valves, namely ΔPTTV-MV measured by TMAD, the difference of systolic time to peak of the tricuspid and mitral valves, namely ΔTsTV-MV measured by TDI, were statistically different between the two groups (P < 0.05). Compared with the non-RBBB group, there were no statistically significant differences in the GLS, RVFAC, LS-RV, TAPSE, TV-s’, SDt-L, SDt-R (P > 0.05). Conclusion Echocardiography technology including two-dimensional speckle tracking imaging (2D-STI), TDI, and TMAD can effectively analyze interventricular synchronization, intraventricular synchronization, and ventricular function. Although the movement of the right ventricular myocardium in the RBBB group was slightly later than that of the left ventricular myocardium after LBBAP, LBBAP could still be applied in RBBB patients with pacing indication.

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Right ventricular septal pacing in patients with right bundle branch block

Cited by 7 publications

References 13 publications

Prevalence and incidence of intra‐ventricular conduction delays and outcomes in patients with heart failure and reduced ejection fraction: insights from PARADIGM‐HF and ATMOSPHERE

Prevalence and incidence of intra‐ventricular conduction delays and outcomes in patients with heart failure and reduced ejection fraction: insights from PARADIGM‐HF and ATMOSPHERE

The electromechanical substrate for response to cardiac resynchronization therapy in patients with right bundle branch block

Early assessment of ventricular synchronization and function after left bundle-branch-area pacing with right bundle-branch block

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