Left ventricular activation time and pattern are preserved with both selective and nonselective His bundle pacing

Area of Science:

• Cardiology
• Electrophysiology
• Cardiac Pacing

Background:

• His bundle pacing (HBP) offers two methods: selective HBP (S-HBP) and nonselective HBP (NS-HBP).
• NS-HBP involves capturing local myocardium, leading to a pre-excited electrocardiogram appearance.

Purpose of the Study:

• To evaluate the impact of ventricular pre-excitation from NS-HBP on left and right ventricular dyssynchrony.
• To compare ventricular activation times and patterns between S-HBP and NS-HBP.

Main Methods:

• Recruited patients exhibiting both S-HBP and NS-HBP.
• Utilized noninvasive epicardial electrical mapping to assess left and right ventricular activation time (LVAT and RVAT) and patterns.

Main Results:

• NS-HBP resulted in a mean within-patient decrease in LVAT of -5.5 ms compared to S-HBP (P < .0001).
• NS-HBP did not significantly prolong RVAT (P = .296) but did prolong QRS duration by 22.1 ms (P = .0003).
• In patients with narrow intrinsic QRS, NS-HBP preserved LVAT but prolonged QRS duration and mean RVAT compared to S-HBP.

Conclusions:

• Local myocardial capture during NS-HBP causes basal right ventricular pre-excitation, prolonging QRS duration.
• NS-HBP effectively preserves the left ventricular activation time and pattern observed with S-HBP.
• Ventricular dyssynchrony is generally not a significant consideration when choosing between S-HBP and NS-HBP.