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. 2022 Jul;27(4):e12954.
doi: 10.1111/anec.12954. Epub 2022 Apr 21.

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

Zak Loring  1   2 , Fredrik Holmqvist  1   3 , Edward Sze  1   4 , Fawaz Alenezi  1 , Kristen Campbell  4   5 , Jason I Koontz  1 , Eric J Velazquez  1   6 , Brett D Atwater  1   7 , Tristram D Bahnson  1 , James P Daubert  1
Affiliations

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

Zak Loring et al. Ann Noninvasive Electrocardiol. 2022 Jul.

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) 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.

Keywords: EP study; His-bundle; echocardiography; first-degree AV-block; pacing.

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Conflict of interest statement

ZL received support from NIH T32 training grant #5T32HL069749, receives grant support from Boston Scientific and serves as a consultant for Huxley Medical and Boston Scientific. FH reports support from the Crafoord Foundation, Eva and Carl‐Eric Larsson Foundation, Bundy Academy and Skåne University Hospital Research Foundation. ES reports no disclosures. FA reports no disclosures. KC reports no disclosures. JIK reports research support from Abbott. EJV reports grants and personal fees from Novartis, during the conduct of the study; grants and personal fees from Amgen, grants from Pfizer, personal fees from Philips, grants from NHLBI, outside the submitted work, BDA reports significant research support from Abbott Medical, and modest Honoraria from Abbott Medical, Biosense Webster, Medtronic, and Biotronik. TDB reports grants from the National Heart, Lung, and Blood Institute (National Institutes of Health) and the Mayo Clinic; has received grants from Boston Scientific, St. Jude Medical Corporation, Biosense Webster, and Medtronic; and has received compensation for consulting from Cardiofocus and Ventrix during the conduct of the study but outside of the submitted work, JPD reports honoraria for advisory boards, events committees, and lectures from Medtronic, Boston Scientific, Abbott, MicroPort, Biotronik, Biosense Webster, Farrapulse, and VytronUS.

Figures

FIGURE 1
FIGURE 1
CONSORT diagram of patient enrollment: Description of screening and exclusion of patients approached for inclusion in this study. AH, atrial‐His; AV, atrial‐ventricular; CHF, congestive heart failure; MI, myocardial infarction; PVI, pulmonary vein isolation
FIGURE 2
FIGURE 2
Change in PR interval between baseline and during atrial pacing. All patients except one (red line) demonstrated a significant increase in PR interval with atrial pacing
See this image and copyright information in PMC

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