Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Jun;34(6):1441-1451.
doi: 10.1111/jce.15927. Epub 2023 May 10.

Optimization of the atrioventricular delay in conduction system pacing

Giovanni Coluccia  1 , Gabriele Dell'Era  2 , Chiara Ghiglieno  2 , Federica De Vecchi  2 , Enrico Spinoni  2 , Matteo Santagostino  2 , Alessandro Guido  1 , Maria Zaccaria  1 , Giuseppe Patti  2 , Michele Accogli  1 , Pietro Palmisano  1
Affiliations

Optimization of the atrioventricular delay in conduction system pacing

Giovanni Coluccia et al. J Cardiovasc Electrophysiol. 2023 Jun.

Abstract

Introduction: In patients receiving conduction system pacing (CSP), it is not well established how to program the sensed atrioventricular delay (sAVD), with respect to the type of capture obtained (selective, nonselective His-bundle [HB] capture or left bundle branch [LBB] capture). The aim of this study was to acutely assess the effectiveness of an electrophysiology (EP)-guided method for sAVD optimization by comparing it with the echocardiogram-guided optimization.

Methods and results: Consecutive patients undergoing HB or LBB pacing were enrolled. The EP-guided sAVD was defined as the sAVD leading to a PR interval of 150 ms on surface electrocardiogram (ECG). In HB pacing patients, EP-guided sAVD was obtained subtracting the time from the onset of the P wave on ECG to the local atrial electrogram (EGM) recorded by the atrial lead (right atrial sensing latency, RASL) and the His-ventricular interval from 150 ms; in LBB pacing patients, subtracting RASL from 150 ms. Transmitral flow assessment by pulsed wave Doppler was used to find the echo-optimized sAVD by a modified iterative method. The discordance between the EP-guided and the echo-optimized sAVD was recorded.

Results: Seventy-one patients were enrolled: 12 with selective, 32 nonselective HB capture, and 27 LBB capture. Overall, the rate of concordance between the EP-guided and the echo-optimized sAVD was 71.8%, with no significant differences between the three groups.

Conclusion: In CSP patients, an optimal sAVD can be programmed, in more than 70% of cases, considering only simple EGM intervals to obtain a physiological PR interval on surface ECG.

Keywords: AV delay optimization; His bundle pacing; conduction system pacing; left bundle branch area pacing.

PubMed Disclaimer

References

REFERENCES

    1. Deshmukh P, Casavant DA, Romanyshyn M, Anderson K. Permanent, direct His-bundle pacing: a novel approach to cardiac pacing in patients with normal His-Purkinje activation. Circulation. 2000;101:869-877.
    1. Vijayaraman P, Naperkowski A, Subzposh FA, et al. Permanent His-bundle pacing: long-term lead performance and clinical outcomes. Heart Rhythm. 2018;15:696-702.
    1. Huang W, Su L, Wu S, et al. A novel pacing strategy with low and stable output: pacing the left bundle branch immediately beyond the conduction block. Can J Cardiol. 2017;33:1736.e1-1736.e3.
    1. Li Y, Chen K, Dai Y, et al. Left bundle branch pacing for symptomatic bradycardia: implant success rate, safety, and pacing characteristics. Heart Rhythm. 2019;16:1758-1765.
    1. Ravi V, Beer D, Pietrasik GM, et al. Development of new-onset or progressive atrial fibrillation in patients with permanent HIS bundle pacing versus right ventricular pacing: results from the RUSH HBP registry. J Am Heart Assoc. 2020;9:e018478.