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JACC. Clinical Electrophysiology Nov 2019More than 2 decades ago, para-Hisian pacing was introduced to assess the pattern of retrograde conduction during electrophysiological studies. Although there is no ideal... (Review)
Review
More than 2 decades ago, para-Hisian pacing was introduced to assess the pattern of retrograde conduction during electrophysiological studies. Although there is no ideal maneuver for every patient and condition, para-Hisian pacing is a valuable and handy strategy to differentiate between retrograde conduction over the atrioventricular node and the accessory pathways. The dynamic behavior of para-Hisian pacing, in a region with unique anatomical features, can produce various activation patterns and intriguing electrophysiological phenomena. Although the demonstration of a retrograde nodal activation pattern during para-Hisian pacing does not rule out the presence of an accessory pathway, evidence of retrograde conduction over an accessory pathway does not prove its active role in the culprit tachycardia. Multipolar His bundle recordings, detailed atrial mapping, and recognition of the truly captured structures and the impact of temporal changes of autonomic tone or pacing rates, are essential keys for accurate interpretation of this maneuver that may ultimately guide judicious catheter ablation of the arrhythmic substrate. This review aims to summarize the practical usefulness and potential pitfalls of the para-Hisian pacing maneuver, focusing on the interpretation of electrocardiograms and intracardiac recordings.
Topics: Accessory Atrioventricular Bundle; Atrioventricular Node; Bundle of His; Cardiac Conduction System Disease; Cardiac Pacing, Artificial; Catheter Ablation; Electrophysiologic Techniques, Cardiac; Heart Conduction System; Humans
PubMed: 31753428
DOI: 10.1016/j.jacep.2019.08.017 -
European Journal of Heart Failure Feb 2023
Topics: Humans; Bundle of His; Heart Failure; Bundle-Branch Block; Cardiac Pacing, Artificial; Cardiac Catheterization; Electrocardiography; Treatment Outcome
PubMed: 36647751
DOI: 10.1002/ejhf.2775 -
Annals of Noninvasive Electrocardiology... Nov 2022This systematic review aimed to explore an association of new TR and its quantification in patients undergoing His bundle pacing (HBP). (Review)
Review
OBJECTIVE
This systematic review aimed to explore an association of new TR and its quantification in patients undergoing His bundle pacing (HBP).
METHODS
A literature review was conducted using Mesh terms (His bundle pacing, tricuspid regurgitation, tricuspid valve incompetence, etc.) in PubMed, EMBASE, Web of science CINAHL, and the Cochrane Library till October 2021. Relevant studies evaluating tricuspid regurgitation in HBP were included and information regarding TR and its related factors (ejection fraction (EF) and New York Heart Association (NYHA) class) were retrieved from the eligible studies.
RESULTS
Out of 196 articles, 10 studies met the inclusion criteria, which consisted of 546 patients with HBP. The mean age of the patients ranged between 61.2 ± 12.3 and 75.1 ± 7.9 years with 54.1% males. The overall implant success rate was 79.2%. Only one study reported a 5% incidence of TR, while 9 studies reported no new TR after HBP. Four studies reported overall decrease in TR by 1 grade and 3 studies demonstrated increased TR from baseline. Two studies showed no change from baseline TR.
CONCLUSION
HBP causes improvement in TR grade after HBP for cardiac resynchronization therapy (CRT) as well as atrioventricular block (AVB). Further studies in the form of randomized controlled trials are required to further evaluate the effect of HBP on tricuspid valve functioning.
Topics: Male; Humans; Middle Aged; Aged; Female; Bundle of His; Tricuspid Valve Insufficiency; Electrocardiography; Treatment Outcome; Cardiac Resynchronization Therapy; Cardiac Pacing, Artificial
PubMed: 35763445
DOI: 10.1111/anec.12986 -
Heart Failure Reviews Mar 2023Cardiac conduction system pacing provides physiological ventricular activation by directly stimulating the conduction system. This review describes the two types of... (Review)
Review
Cardiac conduction system pacing provides physiological ventricular activation by directly stimulating the conduction system. This review describes the two types of conduction system pacing: His bundle pacing (HBP) and left bundle area pacing (LBAP). The most significant advantage of HB pacing is that it can provide a regular, narrow QRS; however, the disadvantages are challenging implantation and a high risk of re-intervention due to lead dislodgement and the development of high pacing threshold. LBAP provides optimum physiological activation of the left ventricle by engaging the left bundle/fascicular fibers. LBAP is more physiological than traditional RV apical pacing and could be an attractive alternative to conventional cardiac resynchronization therapy (CRT). The advantages of LBAP are a relatively more straightforward implantation technique than HBP, better lead stability and pacing thresholds. HBP and LBAP are more physiological than right ventricular pacing and may be used instead of conventional pacemakers. Both HBP and LBBP are being investigated as alternatives to conventional CRT.
Topics: Humans; Bundle of His; Electrocardiography; Treatment Outcome; Heart Conduction System; Cardiac Resynchronization Therapy; Heart Failure; Cardiac Pacing, Artificial
PubMed: 36781809
DOI: 10.1007/s10741-023-10296-4 -
Heart Rhythm Nov 2020His-bundle pacing (HBP) and left bundle pacing (LBP) are emerging as novel delivery methods for cardiac resynchronization therapy (CRT) in heart failure patients with... (Clinical Trial)
Clinical Trial
His-bundle and left bundle pacing with optimized atrioventricular delay achieve superior electrical synchrony over endocardial and epicardial pacing in left bundle branch block patients.
BACKGROUND
His-bundle pacing (HBP) and left bundle pacing (LBP) are emerging as novel delivery methods for cardiac resynchronization therapy (CRT) in heart failure patients with left bundle branch block (LBBB). HBP and LBP have never been compared to biventricular endocardial (BiV-endo) pacing. Furthermore, there are indications of negative effects of LBP on right ventricular (RV) activation times (ATs), but these effects have not been quantified.
OBJECTIVE
The purpose of this study was to compare changes in ventricular activation induced by HBP, LBP, left ventricular (LV) septal pacing, BiV-endo, and biventricular epicardial (BiV-epi) pacing using computer simulations.
METHODS
We simulated ventricular activation on 24 four-chamber heart meshes inclusive of the His-Purkinje network in the presence of LBBB. We simulated BiV-epi pacing, BiV-endo pacing with left ventricular (LV) lead at the lateral wall, BiV-endo pacing with LV lead at the LV septum, HBP, and LBP.
RESULTS
HBP was superior to BiV-endo and BiV-epi in terms of reduction in LV ATs and interventricular dyssynchrony (P <.05). LBP reduced LV ATs but not interventricular dyssynchrony compared to BiV-epi and BiV-endo pacing. RV latest AT was higher with LBP than with HBP (141.3 ± 10.0 ms vs 111.8 ± 10.4 ms). Optimizing AV delay during LBP reduced RV latest AT (104.7 ± 8.7 ms) and led to comparable response to HBP. In case of complete AV block, BiV-endo septal pacing was equivalent to LBP.
CONCLUSION
HBP is superior to BiV-epi and BiV-endo. To achieve comparable response to HBP, AV delay optimization during LBP is required in order to reduce RV ATs.
Topics: Aged; Bundle of His; Bundle-Branch Block; Cardiac Catheterization; Cardiac Resynchronization Therapy; Electrocardiography; Endocardium; Female; Heart Ventricles; Humans; Male; Ventricular Function, Left
PubMed: 32603781
DOI: 10.1016/j.hrthm.2020.06.028 -
BMC Cardiovascular Disorders Aug 2017Long-term RVP could bring adverse problems to cardiac electro-mechanics and result in inter- and intra-ventricular asynchrony, impaired labor force, and aggravation of... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Long-term RVP could bring adverse problems to cardiac electro-mechanics and result in inter- and intra-ventricular asynchrony, impaired labor force, and aggravation of cardiac function. HBRP including direct His bundle pacing and para-His bundle pacing was regarded as a novel physiological pacing pattern to avoid devastating cardiac function. This synthetic study was conducted to integratively and quantitatively evaluate the efficacy of His bundle related pacing (HBRP) in comparison with conventional right ventricular pacing (RVP).
METHODS
Published studies on comparison of left ventricular ejection fraction (LVEF), left ventricular end diastolic volume (LVEDV), left ventricular end systolic volume (LVESV), New York Heart Association (NYHA) class, inter-ventricular asynchrony, and QRS duration, etc. between HBRP and RVP were collected and for meta-analysis.
RESULTS
HBRP showed higher LVEF (WMD = 3.9%, 95% CI: 1.6% - 6.1%), lower NYHA class (WMD = -0.5, 95% CI: -0.7 - -0.3), WMD of LVESV = -0.1 ml, 95% CI: -3.0 - 2.8 ml), less inter-ventricular asynchrony (WMD = -13.2 ms, 95% CI: -16.4 - -10.0 ms), and shorter QRS duration for long-term (WMD = -36.9 ms, 95% CI: -40.0 - -33.8 ms), however, no significant difference of ventricular volume (WMDLVEDV = -2.4 ml, 95% CI: -5.0 - 0.2 ml; WMDLVESV = -0.1 ml, 95% CI: -3.0 - 2.8 ml) compared to RVP.
CONCLUSIONS
The efficacy of HBRP was firstly verified by meta-analysis to date. Compared with RVP, HBRP markedly preserve LVEF, NYHA class, and QRS duration. However, it seemed to have less effect on ventricular volume.
Topics: Action Potentials; Aged; Aged, 80 and over; Bradycardia; Bundle of His; Cardiac Pacing, Artificial; Female; Heart Rate; Heart Ventricles; Humans; Male; Middle Aged; Stroke Volume; Time Factors; Ventricular Function, Left; Ventricular Function, Right
PubMed: 28800733
DOI: 10.1186/s12872-017-0649-4 -
Anatolian Journal of Cardiology Aug 2017The P-QRS-T wave on surface electrocardiogram (ECG) reflects the changes in atrial and ventricular electrical properties. However, the atrioventricular conduction system... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
The P-QRS-T wave on surface electrocardiogram (ECG) reflects the changes in atrial and ventricular electrical properties. However, the atrioventricular conduction system potentials cannot be recorded to date. This study aimed to explore the possibility of micropotential of the atrioventricular conduction system recorded by surface "SAN-Atrial-AVN-His (Saah) ECG."
METHODS
We randomized 100 healthy volunteers (50 females and 50 males; mean age 25.12±1.62 years) to receive "conventional 12-lead ECG" and "Saah ECG," which were recorded by the "Saah ECG" machine. We recorded and further analyzed "conventional 12-lead ECG" and "Saah ECG." According to the microwavelets before the QRS complex, the PR interval was the sum of three intervals: PAs interval (PA interval recorded on surface ECG), AHs interval (AH interval recorded on surface ECG), and HVs interval (HV interval recorded on surface ECG). The PR interval, PAs interval, AHs interval, and HVs interval were measured.
RESULTS
Not only the P-QRS-T waves but also the microwavelets before the P wave, before the QRS complex, and after the QRS complex were recorded in 100 healthy volunteers. The PAs interval, AHs interval, and HVs interval were 22-37 (31.23±2.93) ms, 60-103 (76.07±13.43) ms, and 39-55 (49.29±4.44) ms, respectively. The PAs interval, AHs interval, and HVs interval were consistent with the intracardiac measurements (PA, AH, and HV intervals) obtained in previous studies. Compared with female volunteers, male volunteers had a longer AHs interval (p<0.05).
CONCLUSION
Not only the P-QRS-T waves but also the microwavelets before the P wave, before the QRS complex, and after the QRS complex were recorded on surface ECG. The wavelets before the QRS complex may be related to atrioventricular nodal, His bundle (bundle branch) potentials.
Topics: Adult; Atrioventricular Node; Bundle of His; Electrocardiography; Female; Heart Conduction System; Humans; Male; Predictive Value of Tests; Reference Values; Young Adult
PubMed: 28639947
DOI: 10.14744/AnatolJCardiol.2017.7749 -
Arquivos Brasileiros de Cardiologia Jan 2021
Topics: Bundle of His; Catheter Ablation; Humans; Tachycardia, Atrioventricular Nodal Reentry; Tachycardia, Supraventricular
PubMed: 33566976
DOI: 10.36660/abc.20201149 -
JACC. Clinical Electrophysiology Jul 2020His bundle pacing (HBP) is steadily gaining interest for providing physiological cardiac stimulation. Careful analysis of the electrocardiogram (ECG) is crucial to... (Review)
Review
His bundle pacing (HBP) is steadily gaining interest for providing physiological cardiac stimulation. Careful analysis of the electrocardiogram (ECG) is crucial to confirm capture of conduction tissue, which is a prerequisite for successful HBP at implantation and follow-up. However, interpretation of the ECG with HBP can be challenging. This review provides the reader with practical guidance on how to best use and troubleshoot the 12-lead ECG for HBP in daily clinical practice.
Topics: Bundle of His; Cardiac Pacing, Artificial; Electrocardiography; Follow-Up Studies; Heart Rate; Humans
PubMed: 32703577
DOI: 10.1016/j.jacep.2020.03.005 -
British Heart Journal Aug 1975The atrio-His bundle tracts are very rare; only two have been found in 687 hearts studied histologically. These tracts have a similar appearance to those of the...
The atrio-His bundle tracts are very rare; only two have been found in 687 hearts studied histologically. These tracts have a similar appearance to those of the atrioventricular bundle and form a complete bypass of the atrioventricular node. In their presence the electrocardiogram may show a short or normal PR interval. They may be responsible for some cases of very rapid ventricular response to supraventricular arrhythmias.
Topics: Atrioventricular Node; Bundle of His; Heart Atria; Heart Conduction System; Humans; Middle Aged
PubMed: 1191446
DOI: 10.1136/hrt.37.8.853