December 14, 2011Open Access
View Full PaperLeft ventricular performance during para-His pacing in patients with high-grade atrioventricular block: an acute study
Key Result
Dual-chamber para-His pacing acutely preserved LV systolic performance (mean LVOT-VTI 21.4 vs 19.2 cm, P=0.006) and mechanical synchrony compared with right ventricular septal pacing.
Structured PICO
Does dual-chamber para-His pacing preserve left ventricular performance and mechanical synchrony compared to right ventricular septal pacing in patients with high-grade atrioventricular block?
P
Population
11 patients with high-grade atrioventricular block (AVB) and QRS <120 ms, who had temporary intrinsic atrioventricular (AV) conduction the day after implantation.
I
Intervention
Dual-chamber para-His Pacing (DDD-PHP)
C
Comparator
Atrial-based pacing with intrinsic conduction (AAI) and dual-chamber right ventricular septal pacing (DDD-RVS)
O
Outcome
Changes in left ventricular (LV) performance (LVOT-VTI, LVEF) and mechanical synchrony (maximal time to peak velocity between basal segments) measured acutely via 3D echocardiography and tissue Doppler imagingsurrogate
In patients with high-grade AV block, acute para-His pacing preserves left ventricular systolic performance and mechanical synchrony better than right ventricular septal pacing.
Main Result
Absolute Event Rate: 21.4% vs 19.2%
p-value: p=0.006
Abstract
AIM: To compare changes in left ventricular (LV) performance and mechanical synchrony between atrial-based pacing with intrinsic conduction (AAI), dual-chamber para-His Pacing (DDD-PHP) and dual-chamber right ventricular septal pacing (DDD-RVS) in patients with high-grade atrioventricular block (AVB). METHODS AND RESULTS: Patients with high-grade AVB and QRS <120 ms, who had temporary intrinsic atrioventricular (AV) conduction the day after the implantation were included in the study. All patients received a biventricular pacemaker with a para-His lead in the LV port, and a RVS lead in the right ventricular port. Left ventricular three-dimensional echocardiograms, LV outlet tract-velocity time integrals (LVOT-VTI), and LV synchrony with tissue Doppler imaging were recorded during AAI, DDD-PHP, and DDD-RVS. Eleven patients were included. The mean LVOT-VTI was significant lower during DDD-RVS (19.2 ± 5.5 cm) as compared with DDD-PHP (21.4 ± 5.5 cm), P = 0.006 and AAI (21.6 ± 6.8 cm), P = 0.016. The LVEF was higher during AAI than during DDD-PHP (P= 0.02) and DDD-RVS (P< 0.01). The maximal time to peak velocity between basal segments was significant longer with DDD-RVS (95 ± 26 ms) than with AAI (72 ± 30 ms), P = 0.028, whereas no difference was observed between AAI and DDD-PHP (81 ± 42 ms), P = 0.20. CONCLUSIONS: Acutely, DDD-PHP preserves LV systolic performance and mechanical synchrony as compared with DDD-RVS.