Key result
Non-selective His bundle pacing with a biphasic anodal-first waveform significantly decreased QRS duration compared to sinus rhythm (116 vs 169 ms, P<0.0005) in patients with conduction disturbances.
Why the study?
Does non-selective His bundle pacing with a biphasic anodal-first waveform improve acute electrical and hemodynamic parameters compared to right ventricular apical pacing and sinus rhythm in patients with conduction disturbances and cardiomyopathy?
Does non-selective His bundle pacing with a biphasic anodal-first waveform improve acute electrical and hemodynamic parameters compared to right ventricular apical pacing and sinus rhythm in patients with conduction disturbances and cardiomyopathy?
Absolute Event Rate: 116% vs 169%
p-value: p=< 0.0005
Non-selective His bundle pacing with a biphasic anodal-first waveform acutely improves electrical resynchronization and hemodynamics compared to right ventricular apical pacing in patients with cardiomyopathy and severe conduction disturbances.
Acute QRS shortening seen in small cohort; leaves open hemodynamic or outcome benefits versus standard pacing.
Aims: His bundle pacing has shown to prevent detrimental effects from right ventricular apical pacing (RVA) and proved to resynchronize many conduction disturbances cases. However, the extent of His bundle pacing resynchronization is limited. An optimized stimulation waveform could expand this limit when implemented in His bundle pacing sets. In this work, we temporarily implemented RVA and Non-selective His bundle pacing with a biphasic anodal-first waveform (AF-nHB) and compared their effects against sinus rhythm (SR). Methods and results: Fifteen patients referred for electrophysiologic study with conduction disturbances, cardiomyopathy and ejection fraction below 35% were enrolled for the study. The following acute parameters were measured: QRS duration, left ventricular activation (RLVT), time of isovolumic contraction (IVCT), ejection fraction (EF), and dP/dtmax. QRS duration and RLVT decreased markedly under AF-nHB (SR: 169 ± 34 ms vs. nHB: 116 ± 31 ms, P < 0.0005) while RVA significantly increased QRS duration (SR: 169 ms vs. RVA: 198 ms, P < 0.05) and did not change RLVT (P = NS). Consistently, IVCT moderately decreased under AF-nHB (SR: 238 ms vs. RVA: 184 ms, P < 0.05 vs. SR) and dP/dtmax showed a 93.35 [mmHg] average increase under AF-nHB against SR. Also, T-wave inversions were observed during AF-nHB immediately after SR and RVA pacing suggesting the occurrence of cardiac memory. Conclusions: AF-nHB corrected bundle branch blocks in patients with severe conduction disturbances, even in those with dilated cardiomiopathy, outstanding from RVA. Also, the occurrence of cardiac memory during AF-nHB turned up as an observational finding of this study.
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Ortega et al. (2017) studied Conduction disturbances and cardiomyopathy with ejection fraction <35% (n=15). Non-selective His bundle pacing with a biphasic anodal-first waveform (AF-nHB) vs. Sinus rhythm (SR) and right ventricular apical pacing (RVA) was evaluated on QRS duration (p=< 0.0005). Non-selective His bundle pacing with a biphasic anodal-first waveform significantly decreased QRS duration compared to sinus rhythm (116 vs 169 ms, P<0.0005) in patients with conduction disturbances.
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