Acute echocardiographic and hemodynamic response to his-bundle pacing in patients with first-degree atrioventricular block
(2022) In Annals of Noninvasive Electrocardiology 27(4).- Abstract
Background: Atrial pacing and right ventricular (RV) pacing are both associated with adverse outcomes among patients with first-degree atrioventricular block (1°AVB). His-bundle pacing (HBP) provides physiological activation of the ventricle and may be able to improve both atrioventricular (AV) and inter-ventricular synchrony in 1°AVB patients. This study evaluates the acute echocardiographic and hemodynamic effects of atrial, atrial-His-bundle sequential (AH), and atrial-ventricular (AV) sequential pacing in 1°AVB patients. Methods: Patients with 1°AVB undergoing atrial fibrillation ablation were included. Following left atrial (LA) catheterization, patients underwent atrial, AH- and AV-sequential pacing. LA/left ventricular (LV)... (More)
Background: Atrial pacing and right ventricular (RV) pacing are both associated with adverse outcomes among patients with first-degree atrioventricular block (1°AVB). His-bundle pacing (HBP) provides physiological activation of the ventricle and may be able to improve both atrioventricular (AV) and inter-ventricular synchrony in 1°AVB patients. This study evaluates the acute echocardiographic and hemodynamic effects of atrial, atrial-His-bundle sequential (AH), and atrial-ventricular (AV) sequential pacing in 1°AVB patients. Methods: Patients with 1°AVB undergoing atrial fibrillation ablation were included. Following left atrial (LA) catheterization, patients underwent atrial, AH- and AV-sequential pacing. LA/left ventricular (LV) pressure and echocardiographic measurements during the pacing protocols were compared. Results: Thirteen patients with 1°AVB (mean PR 221 ± 26 ms) were included. The PR interval was prolonged with atrial pacing compared to baseline (275 ± 73 ms, p =.005). LV ejection fraction (LVEF) was highest during atrial pacing (62 ± 11%), intermediate with AH-sequential pacing (59 ± 7%), and lowest with AV-sequential pacing (57 ± 12%) though these differences were not statistically significant. No significant differences were found in LA or LV mean pressures or LV dP/dT. LA and LV volumes, isovolumetric times, electromechanical delays, and global longitudinal strains were similar across pacing protocols. Conclusion: Despite pronounced PR prolongation, the acute effects of atrial pacing were not significantly different than AH- or AV-sequential pacing. Normalizing atrioventricular and/or inter-ventricular dyssynchrony did not result in acute improvements in cardiac output or loading conditions.
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- author
- Loring, Zak ; Holmqvist, Fredrik LU ; Sze, Edward ; Alenezi, Fawaz ; Campbell, Kristen ; Koontz, Jason I. ; Velazquez, Eric J. ; Atwater, Brett D. ; Bahnson, Tristram D. and Daubert, James P.
- organization
- publishing date
- 2022
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- echocardiography, EP study, first-degree AV-block, His-bundle, pacing
- in
- Annals of Noninvasive Electrocardiology
- volume
- 27
- issue
- 4
- publisher
- Wiley-Blackwell
- external identifiers
-
- scopus:85128351928
- pmid:35445488
- ISSN
- 1082-720X
- DOI
- 10.1111/anec.12954
- language
- English
- LU publication?
- yes
- id
- 08f58af7-908b-4568-9936-1c9b585c7e10
- date added to LUP
- 2022-07-05 14:36:52
- date last changed
- 2024-05-28 19:12:19
@article{08f58af7-908b-4568-9936-1c9b585c7e10,
abstract = {{<p>Background: Atrial pacing and right ventricular (RV) pacing are both associated with adverse outcomes among patients with first-degree atrioventricular block (1°AVB). His-bundle pacing (HBP) provides physiological activation of the ventricle and may be able to improve both atrioventricular (AV) and inter-ventricular synchrony in 1°AVB patients. This study evaluates the acute echocardiographic and hemodynamic effects of atrial, atrial-His-bundle sequential (AH), and atrial-ventricular (AV) sequential pacing in 1°AVB patients. Methods: Patients with 1°AVB undergoing atrial fibrillation ablation were included. Following left atrial (LA) catheterization, patients underwent atrial, AH- and AV-sequential pacing. LA/left ventricular (LV) pressure and echocardiographic measurements during the pacing protocols were compared. Results: Thirteen patients with 1°AVB (mean PR 221 ± 26 ms) were included. The PR interval was prolonged with atrial pacing compared to baseline (275 ± 73 ms, p =.005). LV ejection fraction (LVEF) was highest during atrial pacing (62 ± 11%), intermediate with AH-sequential pacing (59 ± 7%), and lowest with AV-sequential pacing (57 ± 12%) though these differences were not statistically significant. No significant differences were found in LA or LV mean pressures or LV dP/dT. LA and LV volumes, isovolumetric times, electromechanical delays, and global longitudinal strains were similar across pacing protocols. Conclusion: Despite pronounced PR prolongation, the acute effects of atrial pacing were not significantly different than AH- or AV-sequential pacing. Normalizing atrioventricular and/or inter-ventricular dyssynchrony did not result in acute improvements in cardiac output or loading conditions.</p>}},
author = {{Loring, Zak and Holmqvist, Fredrik and Sze, Edward and Alenezi, Fawaz and Campbell, Kristen and Koontz, Jason I. and Velazquez, Eric J. and Atwater, Brett D. and Bahnson, Tristram D. and Daubert, James P.}},
issn = {{1082-720X}},
keywords = {{echocardiography; EP study; first-degree AV-block; His-bundle; pacing}},
language = {{eng}},
number = {{4}},
publisher = {{Wiley-Blackwell}},
series = {{Annals of Noninvasive Electrocardiology}},
title = {{Acute echocardiographic and hemodynamic response to his-bundle pacing in patients with first-degree atrioventricular block}},
url = {{http://dx.doi.org/10.1111/anec.12954}},
doi = {{10.1111/anec.12954}},
volume = {{27}},
year = {{2022}},
}