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Acute echocardiographic and hemodynamic response to his-bundle pacing in patients with first-degree atrioventricular block

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. (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
; ; ; ; ; ; ; ; and
organization
publishing date
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
  • pmid:35445488
  • scopus:85128351928
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}},
}