Electrocardiographic predictors of successful resynchronization of left bundle branch block by His bundle pacing.

Autor: Arnold AD; National Heart and Lung Institute, Imperial College London, Hammersmith Hospital, London, UK., Shun-Shin MJ; National Heart and Lung Institute, Imperial College London, Hammersmith Hospital, London, UK., Keene D, Howard JP; National Heart and Lung Institute, Imperial College London, Hammersmith Hospital, London, UK., Chow JJ; National Heart and Lung Institute, Imperial College London, Hammersmith Hospital, London, UK., Lim E; National Heart and Lung Institute, Imperial College London, Hammersmith Hospital, London, UK., Lampridou S; National Heart and Lung Institute, Imperial College London, Hammersmith Hospital, London, UK., Miyazawa AA; National Heart and Lung Institute, Imperial College London, Hammersmith Hospital, London, UK., Muthumala A; Cardiology Department, North Middlesex University Hospital NHS Trust, London, UK.; Cardiology Department, St. Bartholomew's Hospital, Barts Health NHS Trust, London, UK., Tanner M; National Heart and Lung Institute, Imperial College London, Hammersmith Hospital, London, UK., Qureshi NA; National Heart and Lung Institute, Imperial College London, Hammersmith Hospital, London, UK., Lefroy DC; National Heart and Lung Institute, Imperial College London, Hammersmith Hospital, London, UK., Koa-Wing M; National Heart and Lung Institute, Imperial College London, Hammersmith Hospital, London, UK., Linton NWF; National Heart and Lung Institute, Imperial College London, Hammersmith Hospital, London, UK., Boon Lim P; National Heart and Lung Institute, Imperial College London, Hammersmith Hospital, London, UK., Peters NS; National Heart and Lung Institute, Imperial College London, Hammersmith Hospital, London, UK., Kanagaratnam P; National Heart and Lung Institute, Imperial College London, Hammersmith Hospital, London, UK., Auricchio A; Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland., Francis DP; National Heart and Lung Institute, Imperial College London, Hammersmith Hospital, London, UK., Whinnett ZI; National Heart and Lung Institute, Imperial College London, Hammersmith Hospital, London, UK.
Jazyk: angličtina
Zdroj: Journal of cardiovascular electrophysiology [J Cardiovasc Electrophysiol] 2021 Feb; Vol. 32 (2), pp. 428-438. Date of Electronic Publication: 2021 Jan 04.
DOI: 10.1111/jce.14845
Abstrakt: 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.
(© 2020 The Authors. Journal of Cardiovascular Electrophysiology published by Wiley Periodicals LLC.)
Databáze: MEDLINE
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