Imperial College London
Alternate

ProfessorDarrelFrancis

Faculty of Medicine, National Heart & Lung Institute

Professor of Cardiology
 
 
 
//

Contact

 

+44 (0)20 7594 3381d.francis Website

 
 
//

Assistant

 

Miss Juliet Holmes +44 (0)20 7594 5735

 
//

Location

 

Block B Hammersmith HospitalHammersmith Campus

//

Summary

 

Publications

Citation

BibTex format

@article{Arnold:2021:10.1016/j.hroo.2021.08.001,
author = {Arnold, AD and Shun-Shin, MJ and Ali, N and Keene, D and Howard, JP and Chow, J-J and Qureshi, NA and Koa-Wing, M and Tanner, M and Lefroy, DC and Linton, NWF and Ng, FS and Lim, PB and Peters, NS and Kanagaratnam, P and Francis, DP and Whinnett, ZI},
doi = {10.1016/j.hroo.2021.08.001},
journal = {Heart Rhythm O2},
pages = {439--445},
title = {Left ventricular activation time and pattern are preserved with both selective and non-selective his bundle pacing},
url = {http://dx.doi.org/10.1016/j.hroo.2021.08.001},
volume = {2},
year = {2021}
}
Download

RIS format (EndNote, RefMan)

TY  - JOUR
AB  - BackgroundHis bundle pacing (HBP) can be achieved in two ways: selective HBP (S-HBP), where the His bundle is captured alone, and non-selective HBP (NS-HBP), where local myocardium is also captured resulting a pre-excited ECG appearance.ObjectiveWe assessed the impact of this ventricular pre-excitation on left and right ventricular dys-synchrony.MethodsWe recruited patients who displayed both S-HBP and NS-HBP. We performed non-invasive epicardial electrical mapping for left and right ventricular activation time (LVAT and RVAT) and pattern.Results20 patients were recruited. In the primary analysis, the mean within-patient change in LVAT from S-HBP to NS-HBP was -5.5ms (95% confidence interval: -0.6 to -10.4, non-inferiority p<0.0001). NS-HBP did not prolong RVAT (4.3ms, -4.0 to 12.8, p=0.296) but did prolong QRS duration (QRSd, 22.1ms, 11.8 to 32.4, p = 0.0003). In patients with narrow intrinsic QRS (n=6), NS-HBP preserved LVAT (-2.9ms, -9.7 to 4.0, p=0.331) but prolonged QRS duration (31.4ms, 22.0 to 40.7, p=0.0003) and mean RVAT (16.8ms, -5.3 to 38.9, p=0.108) compared to S-HBP. Activation pattern of the left ventricular surface was unchanged between S-HBP and NS-HBP but NS-HBP produced early basal right ventricular activation that was not seen in S-HBP.ConclusionCompared to S-HBP, local myocardial capture during NS-HBP produces pre-excitation of the basal right ventricle resulting in QRS duration prolongation. However, NS-HBP preserves the left ventricular activation time and pattern of S-HBP. Left ventricular dys-synchrony is not an important factor when choosing between S-HBP and NS-HBP in most patients.
AU  - Arnold,AD
AU  - Shun-Shin,MJ
AU  - Ali,N
AU  - Keene,D
AU  - Howard,JP
AU  - Chow,J-J
AU  - Qureshi,NA
AU  - Koa-Wing,M
AU  - Tanner,M
AU  - Lefroy,DC
AU  - Linton,NWF
AU  - Ng,FS
AU  - Lim,PB
AU  - Peters,NS
AU  - Kanagaratnam,P
AU  - Francis,DP
AU  - Whinnett,ZI
DO  - 10.1016/j.hroo.2021.08.001
EP  - 445
PY  - 2021///
SN  - 2666-5018
SP  - 439
TI  - Left ventricular activation time and pattern are preserved with both selective and non-selective his bundle pacing
T2  - Heart Rhythm O2
UR  - http://dx.doi.org/10.1016/j.hroo.2021.08.001
UR  - https://www.sciencedirect.com/science/article/pii/S2666501821001537?via%3Dihub
UR  - http://hdl.handle.net/10044/1/91128
VL  - 2
ER  -
Download