Imperial College London
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Dr Fu Siong Ng

Faculty of Medicine, National Heart & Lung Institute

Reader in Cardiac Electrophysiology
 
 
 
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Contact

 

+44 (0)20 7594 3614f.ng Website

 
 
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Location

 

430ICTEM buildingHammersmith Campus

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Summary

 

Publications

Citation

BibTex format

@article{Arnold:2021,
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},
journal = {Heart rhythm O2},
pages = {439--445},
title = {Left ventricular activation time and pattern are preserved with both selective and nonselective His bundle pacing},
volume = {2},
year = {2021}
}
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RIS format (EndNote, RefMan)

TY  - JOUR
AB  - <h4>Background</h4> His bundle pacing (HBP) can be achieved in 2 ways: selective HBP (S-HBP), where the His bundle is captured alone, and nonselective HBP (NS-HBP), where local myocardium is also captured, resulting a pre-excited electrocardiogram appearance. <h4>Objective</h4> We assessed the impact of this ventricular pre-excitation on left and right ventricular dyssynchrony. <h4>Methods</h4> We recruited patients who displayed both S-HBP and NS-HBP. We performed noninvasive epicardial electrical mapping for left and right ventricular activation time (LVAT and RVAT) and pattern. <h4>Results</h4> Twenty patients were recruited. In the primary analysis, the mean within-patient change in LVAT from S-HBP to NS-HBP was -5.5 ms (95% confidence interval: -0.6 to -10.4, noninferiority P < .0001). NS-HBP did not prolong RVAT (4.3 ms, -4.0 to 12.8, P = .296) but did prolong QRS duration (QRSd, 22.1 ms, 11.8 to 32.4, P = .0003). In patients with narrow intrinsic QRS (n = 6), NS-HBP preserved LVAT (-2.9 ms, -9.7 to 4.0, P = .331) but prolonged QRS duration (31.4 ms, 22.0 to 40.7, P = .0003) and mean RVAT (16.8 ms, -5.3 to 38.9, P = .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. <h4>Conclusion</h4> Compared 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 dyssynchrony is not an important factor when choosing between S-HBP and NS-HBP in most patients. Graphical abstract
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
EP  - 445
PY  - 2021///
SN  - 2666-5018
SP  - 439
TI  - Left ventricular activation time and pattern are preserved with both selective and nonselective His bundle pacing
T2  - Heart rhythm O2
VL  - 2
ER  -
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