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Electrocardiographic predictors of successful resynchronization of left bundle branch block by His bundle pacing
BACKGROUND: His bundle pacing (HBP) is an alternative to biventricular pacing (BVP) for delivering cardiac resynchronization therapy (CRT) in patients with heart failure and left bundle branch block (LBBB). It is not known whether ventricular activation times and patterns achieved by HBP are equival...
Autores principales: | , , , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
John Wiley and Sons Inc.
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8607473/ https://www.ncbi.nlm.nih.gov/pubmed/33345379 http://dx.doi.org/10.1111/jce.14845 |
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author | Arnold, Ahran D. Shun‐Shin, Matthew J. Keene, Daniel Howard, James P. Chow, Ji‐Jian Lim, Elaine Lampridou, Smaragda Miyazawa, Alejandra A. Muthumala, Amal Tanner, Mark Qureshi, Norman A. Lefroy, David C. Koa‐Wing, Michael Linton, Nick W. F. Boon Lim, Phang Peters, Nicholas S. Kanagaratnam, Prapa Auricchio, Angelo Francis, Darrel P. Whinnett, Zachary I. |
author_facet | Arnold, Ahran D. Shun‐Shin, Matthew J. Keene, Daniel Howard, James P. Chow, Ji‐Jian Lim, Elaine Lampridou, Smaragda Miyazawa, Alejandra A. Muthumala, Amal Tanner, Mark Qureshi, Norman A. Lefroy, David C. Koa‐Wing, Michael Linton, Nick W. F. Boon Lim, Phang Peters, Nicholas S. Kanagaratnam, Prapa Auricchio, Angelo Francis, Darrel P. Whinnett, Zachary I. |
author_sort | Arnold, Ahran D. |
collection | PubMed |
description | BACKGROUND: His bundle pacing (HBP) is an alternative to biventricular pacing (BVP) for delivering cardiac resynchronization therapy (CRT) in patients with heart failure and left bundle branch block (LBBB). It is not known whether ventricular activation times and patterns achieved by HBP are equivalent to intact conduction systems and not all patients with LBBB are resynchronized by HBP. OBJECTIVE: To compare activation times and patterns of His‐CRT with BVP‐CRT, LBBB and intact conduction systems. METHODS: In patients with LBBB, noninvasive epicardial mapping (ECG imaging) was performed during BVP and temporary HBP. Intrinsic activation was mapped in all subjects. Left ventricular activation times (LVAT) were measured and epicardial propagation mapping (EPM) was performed, to visualize epicardial wavefronts. Normal activation pattern and a normal LVAT range were determined from normal subjects. RESULTS: Forty‐five patients were included, 24 with LBBB and LV impairment, and 21 with normal 12‐lead ECG and LV function. In 87.5% of patients with LBBB, His‐CRT successfully shortened LVAT by ≥10 ms. In 33.3%, His‐CRT resulted in complete ventricular resynchronization, with activation times and patterns indistinguishable from normal subjects. EPM identified propagation discontinuity artifacts in 83% of patients with LBBB. This was the best predictor of whether successful resynchronization was achieved by HBP (logarithmic odds ratio, 2.19; 95% confidence interval, 0.07–4.31; p = .04). CONCLUSION: Noninvasive electrocardiographic mapping appears to identify patients whose LBBB can be resynchronized by HBP. In contrast to BVP, His‐CRT may deliver the maximum potential ventricular resynchronization, returning activation times, and patterns to those seen in normal hearts. |
format | Online Article Text |
id | pubmed-8607473 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | John Wiley and Sons Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-86074732021-11-29 Electrocardiographic predictors of successful resynchronization of left bundle branch block by His bundle pacing Arnold, Ahran D. Shun‐Shin, Matthew J. Keene, Daniel Howard, James P. Chow, Ji‐Jian Lim, Elaine Lampridou, Smaragda Miyazawa, Alejandra A. Muthumala, Amal Tanner, Mark Qureshi, Norman A. Lefroy, David C. Koa‐Wing, Michael Linton, Nick W. F. Boon Lim, Phang Peters, Nicholas S. Kanagaratnam, Prapa Auricchio, Angelo Francis, Darrel P. Whinnett, Zachary I. J Cardiovasc Electrophysiol Original Articles BACKGROUND: His bundle pacing (HBP) is an alternative to biventricular pacing (BVP) for delivering cardiac resynchronization therapy (CRT) in patients with heart failure and left bundle branch block (LBBB). It is not known whether ventricular activation times and patterns achieved by HBP are equivalent to intact conduction systems and not all patients with LBBB are resynchronized by HBP. OBJECTIVE: To compare activation times and patterns of His‐CRT with BVP‐CRT, LBBB and intact conduction systems. METHODS: In patients with LBBB, noninvasive epicardial mapping (ECG imaging) was performed during BVP and temporary HBP. Intrinsic activation was mapped in all subjects. Left ventricular activation times (LVAT) were measured and epicardial propagation mapping (EPM) was performed, to visualize epicardial wavefronts. Normal activation pattern and a normal LVAT range were determined from normal subjects. RESULTS: Forty‐five patients were included, 24 with LBBB and LV impairment, and 21 with normal 12‐lead ECG and LV function. In 87.5% of patients with LBBB, His‐CRT successfully shortened LVAT by ≥10 ms. In 33.3%, His‐CRT resulted in complete ventricular resynchronization, with activation times and patterns indistinguishable from normal subjects. EPM identified propagation discontinuity artifacts in 83% of patients with LBBB. This was the best predictor of whether successful resynchronization was achieved by HBP (logarithmic odds ratio, 2.19; 95% confidence interval, 0.07–4.31; p = .04). CONCLUSION: Noninvasive electrocardiographic mapping appears to identify patients whose LBBB can be resynchronized by HBP. In contrast to BVP, His‐CRT may deliver the maximum potential ventricular resynchronization, returning activation times, and patterns to those seen in normal hearts. John Wiley and Sons Inc. 2021-01-04 2021-02 /pmc/articles/PMC8607473/ /pubmed/33345379 http://dx.doi.org/10.1111/jce.14845 Text en © 2020 The Authors. Journal of Cardiovascular Electrophysiology published by Wiley Periodicals LLC. https://creativecommons.org/licenses/by/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Original Articles Arnold, Ahran D. Shun‐Shin, Matthew J. Keene, Daniel Howard, James P. Chow, Ji‐Jian Lim, Elaine Lampridou, Smaragda Miyazawa, Alejandra A. Muthumala, Amal Tanner, Mark Qureshi, Norman A. Lefroy, David C. Koa‐Wing, Michael Linton, Nick W. F. Boon Lim, Phang Peters, Nicholas S. Kanagaratnam, Prapa Auricchio, Angelo Francis, Darrel P. Whinnett, Zachary I. Electrocardiographic predictors of successful resynchronization of left bundle branch block by His bundle pacing |
title | Electrocardiographic predictors of successful resynchronization of left bundle branch block by His bundle pacing |
title_full | Electrocardiographic predictors of successful resynchronization of left bundle branch block by His bundle pacing |
title_fullStr | Electrocardiographic predictors of successful resynchronization of left bundle branch block by His bundle pacing |
title_full_unstemmed | Electrocardiographic predictors of successful resynchronization of left bundle branch block by His bundle pacing |
title_short | Electrocardiographic predictors of successful resynchronization of left bundle branch block by His bundle pacing |
title_sort | electrocardiographic predictors of successful resynchronization of left bundle branch block by his bundle pacing |
topic | Original Articles |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8607473/ https://www.ncbi.nlm.nih.gov/pubmed/33345379 http://dx.doi.org/10.1111/jce.14845 |
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