Hemodynamic Effects of Permanent His Bundle Pacing Compared to Right Ventricular Pacing Assessed by Two-Dimensional...

Area of Science:

• Cardiology
• Electrophysiology
• Cardiac Pacing

Background:

• Atrioventricular conduction disorders necessitate pacing, with right ventricular pacing (RVP) being common.
• RVP can lead to dyssynchrony and adverse cardiac remodeling.
• His bundle pacing (HBP) is an alternative pacing strategy with potential benefits.

Purpose of the Study:

• To compare the long-term effects of HBP versus RVP on cardiac function and synchrony.
• To evaluate echocardiographic parameters, including global longitudinal strain (GLS) and peak systolic dispersion (PSD), after 6 months.
• To assess pacing parameters and QRS duration (QRSd) in both pacing groups.

Main Methods:

• A comparative study involving patients with atrioventricular conduction disorders and preserved left ventricular ejection fraction (LVEF).
• Patients were randomized to either RVP (n=26) or HBP (n=24).
• Evaluations included 2D speckle-tracking echocardiography for GLS and PSD, left atrial volume index (LAVI) and QRSd measurements, and sensing/pacing threshold testing at 1 day and 6 months post-implantation.

Main Results:

• HBP demonstrated stable GLS and decreasing PSD, indicating preserved ventricular synchrony.
• RVP showed a decrease in GLS and an increase in PSD, suggesting impaired synchrony.
• RVP resulted in longer QRSd and increased LAVI compared to HBP, which showed a decrease in LAVI.

Conclusions:

• His bundle pacing maintains ventricular synchrony and shows favorable remodeling compared to right ventricular pacing.
• HBP is a superior pacing strategy for patients with atrioventricular conduction disorders, offering better preservation of cardiac function.
• These findings support HBP as an alternative to RVP, particularly in patients concerned about long-term cardiac health.