Key result
Distal HBP corrects LV delay at varying voltage outputs in a case of intra-Hisian LBBB.
Why the study?
Evidence was lacking regarding the possibility of pacing selective His bundle partitions destined to form branches and fascicles.
Case Report (n=1)
This case provides clinical evidence supporting the longitudinal dissociation of the His bundle by demonstrating output-dependent selective fascicular capture during distal His bundle pacing.
Supports longitudinal dissociation of the His bundle via output-dependent capture in one case; hypothesis-generating and should not yet change practice.
INTRODUCTION: Histological studies reported that the His bundle (HB) is partitioned into narrow cords by collagen running in its long axis, providing the anatomical setting necessary for its longitudinal dissociation. Further confirmations came from the demonstration that direct HB pacing normalizes the QRS axis and duration in subjects with proximal HB lesions causing bundle branch block. However, there is no evidence of the possibility of selective HB partitions pacing destined to the composition of branches and fascicles. METHODS AND RESULTS: We describe a case of intra-Hisian left bundle branch block in which permanent distal HB pacing corrects left ventricular delay and produces different QRS morphology at different voltage outputs, as an expression of different selective HB compartments recruitment. CONCLUSION: This case would strengthen the limited data in the literature about HB longitudinal dissociation.
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Marinaccio et al. (2021) conducted a case report in Intra-Hisian left bundle branch block (n=1). Permanent distal His bundle pacing was evaluated on Correction of left ventricular delay and QRS morphology. Permanent distal His bundle pacing corrected left ventricular delay and produced different QRS morphologies at different voltage outputs in a patient with intra-Hisian left bundle branch block.
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