Key result
His bundle pacing shortens QRS duration by ~33 ms vs. RVP, preserving ventricular synchrony.
Why the study?
Does His bundle pacing improve electrical and mechanical ventricular synchrony compared to right ventricular pacing in patients with atrioventricular conduction disorders and preserved LVEF?
RCT (n=50)
Randomly assigned
No
Does His bundle pacing improve electrical and mechanical ventricular synchrony compared to right ventricular pacing in patients with atrioventricular conduction disorders and preserved LVEF?
Absolute Event Rate: 112.3% vs 145%
p-value: p=<0.001
His bundle pacing preserves electrical and mechanical ventricular synchrony compared to right ventricular pacing, preventing pacing-induced systolic and diastolic dysfunction as measured by speckle-tracking echocardiography.
Supports preferring His bundle over right ventricular pacing to preserve synchrony in AV block with preserved LVEF; extends randomized evidence for physiological pacing.
We compared the effects of right ventricular (RVP; n = 26) and His bundle (HBP; n = 24) pacing in patients with atrioventricular conduction disorders and preserved LVEF. Postoperatively (1D), and after six months (6M), the patients underwent global longitudinal strain (GLS) and peak systolic dispersion (PSD) evaluation with 2D speckle-tracking echocardiography, assessment of left atrial volume index (LAVI) and QRS duration (QRSd), and sensing/pacing parameter testing. The RVP threshold was lower than the HBP threshold at 1D (0.65 ± 0.13 vs. 1.05 ± 0.20 V, p < 0.001), and then it remained stable, while the HBP threshold increased at 6M (1.05 ± 0.20 vs. 1.31 ± 0.30 V, p < 0.001). The RVP R-wave was higher than the HBP R-wave at 1D (11.52 ± 2.99 vs. 4.82 ± 1.41 mV, p < 0.001). The RVP R-wave also remained stable, while the HBP R-wave decreased at 6M (4.82 ± 1.41 vs. 4.50 ± 1.09 mV, p < 0.02). RVP QRSd was longer than HBP QRSd at 6M (145.0 ± 11.1 vs. 112.3 ± 9.3 ms, p < 0.001). The absolute value of RVP GLS decreased at 6M (16.32 ± 2.57 vs. 14.03 ± 3.78%, p < 0.001), and HBP GLS remained stable. Simultaneously, RVP PSD increased (72.53 ± 24.15 vs. 88.33 ± 30.51 ms, p < 0.001) and HBP PSD decreased (96.28 ± 33.99 vs. 84.95 ± 28.98 ms, p < 0.001) after 6 months. RVP LAVI increased (26.73 ± 5.7 vs. 28.40 ± 6.4 mL/m2, p < 0.05), while HBP LAVI decreased at 6M (30.03 ± 7.8 vs. 28.73 ± 8.7 mL/m2, p < 0.01). These results confirm that HBP does not disrupt ventricular synchrony and provides advantages over RVP.
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Michalik et al. (2021) conducted an RCT in Atrioventricular conduction disorders with preserved LVEF (n=50). His bundle pacing vs. Right ventricular pacing was evaluated on QRS duration at 6 months (p=<0.001). His bundle pacing prevented the disruption of ventricular synchrony seen with right ventricular pacing, resulting in a significantly shorter QRS duration (112.3 vs. 145.0 ms) at 6 months.
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