Imperial College London
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DrAhranArnold

Faculty of Medicine, National Heart & Lung Institute

Clinical Senior Lecturer in Cardiology
 
 
 
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ahran.arnold

 
 
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Location

 

Fellows' RoomBlock B Hammersmith HospitalHammersmith Campus

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Summary

 

Publications

Citation

BibTex format

@article{Keene:2020:10.1111/jce.14763,
author = {Keene, D and Shun-Shin, MJ and Arnold, AD and March, K and Qureshi, N and Ng, FS and Tanner, M and Linton, N and Lim, PB and Lefroy, D and Kanagaratnam, P and Peters, NS and Francis, DP and Whinnett, ZI},
doi = {10.1111/jce.14763},
journal = {Journal of Cardiovascular Electrophysiology},
pages = {2964--2974},
title = {Within-patient comparison of His-bundle pacing, right ventricular pacing, and right ventricular pacing avoidance algorithms in patients with PR prolongation: Acute hemodynamic study},
url = {http://dx.doi.org/10.1111/jce.14763},
volume = {31},
year = {2020}
}
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RIS format (EndNote, RefMan)

TY  - JOUR
AB  - AimsA prolonged PR interval may adversely affect ventricular filling and, therefore, cardiac function. AV delay can be corrected using right ventricular pacing (RVP), but this induces ventricular dyssynchrony, itself harmful. Therefore, in intermittent heart block, pacing avoidance algorithms are often implemented. We tested Hisbundle pacing (HBP) as an alternative.MethodsOutpatients with a long PR interval (>200 ms) and intermittent need for ventricular pacing were recruited. We measured withinpatient differences in highprecision hemodynamics between AVoptimized RVP and HBP, as well as a pacing avoidance algorithm (Managed Ventricular Pacing [MVP]).ResultsWe recruited 18 patients. Mean left ventricular ejection fraction was 44.3 ± 9%. Mean intrinsic PR interval was 266 ± 42 ms and QRS duration was 123 ± 29 ms. RVP lengthened QRS duration (+54 ms, 95% CI 42–67 ms, p < .0001) while HBP delivered a shorter QRS duration than RVP (−56 ms, 95% CI −67 to −46 ms, p < .0001). HBP did not increase QRS duration (−2 ms, 95% CI −8 to 13 ms, p = .6). HBP improved acute systolic blood pressure by mean of 5.0 mmHg (95% CI 2.8–7.1 mmHg, p < .0001) compared to RVP and by 3.5 mmHg (95% CI 1.9–5.0 mmHg, p = .0002) compared to the pacing avoidance algorithm. There was no significant difference in hemodynamics between RVP and ventricular pacing avoidance (p = .055).ConclusionsHBP provides better acute cardiac function than pacing avoidance algorithms and RVP, in patients with prolonged PR intervals. HBP allows normalization of prolonged AV delays (unlike pacing avoidance) and does not cause ventricular dyssynchrony (unlike RVP). Clinical trials may be justified to assess whether these acute
AU  - Keene,D
AU  - Shun-Shin,MJ
AU  - Arnold,AD
AU  - March,K
AU  - Qureshi,N
AU  - Ng,FS
AU  - Tanner,M
AU  - Linton,N
AU  - Lim,PB
AU  - Lefroy,D
AU  - Kanagaratnam,P
AU  - Peters,NS
AU  - Francis,DP
AU  - Whinnett,ZI
DO  - 10.1111/jce.14763
EP  - 2974
PY  - 2020///
SN  - 1045-3873
SP  - 2964
TI  - Within-patient comparison of His-bundle pacing, right ventricular pacing, and right ventricular pacing avoidance algorithms in patients with PR prolongation: Acute hemodynamic study
T2  - Journal of Cardiovascular Electrophysiology
UR  - http://dx.doi.org/10.1111/jce.14763
UR  - http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000574941800001&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=1ba7043ffcc86c417c072aa74d649202
UR  - https://onlinelibrary.wiley.com/doi/10.1111/jce.14763
UR  - http://hdl.handle.net/10044/1/84638
VL  - 31
ER  -
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