Depolarization and repolarization dynamics after His-bundle pacing: Comparison with right ventricular pacing and
Satoshi Yanagisawa1,2, Yasuya Inden2, Ryo Watanabe2
1Department of Advanced Cardiovascular Therapeutics, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Summary
His-bundle pacing (HBP) demonstrates superior electrical stability compared to right ventricular pacing (RVP), leading to reduced ventricular arrhythmias (VA). HBP offers a safer alternative for patients requiring cardiac pacing.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Devices
Background:
- Cardiac pacing is essential for managing bradyarrhythmias.
- Right ventricular pacing (RVP) can lead to dyssynchronous ventricular activation.
- His-bundle pacing (HBP) offers a potentially more physiological alternative to RVP.
Purpose of the Study:
- To compare electrical depolarization and repolarization changes between HBP and RVP.
- To assess the association between pacing type and ventricular arrhythmia (VA) occurrence.
- To evaluate long-term safety and efficacy of HBP versus RVP.
Main Methods:
- A comparative study involving 41 patients: 13 HBP, 14 RVP, and 14 controls (AAI mode).
- Electrocardiographic parameters (QRS duration, QT interval, Tpe, Tpe/QT ratio) were measured at baseline and up to 6 months post-implantation.
- Ventricular arrhythmia (VA) occurrence and adverse events were monitored.
Main Results:
- HBP group showed significantly shorter QRS duration and lower QT intervals compared to RVP at 6 months.
- T-peak to T-end (Tpe) and Tpe/QT ratio were significantly lower in the HBP group than in the RVP group.
- Ventricular arrhythmia (VA) occurred less frequently in the HBP group (15%) compared to the RVP group (50%).
Conclusions:
- His-bundle pacing (HBP) provides better depolarization and repolarization stability than RVP.
- HBP is associated with a lower incidence of ventricular arrhythmias and adverse events.
- HBP represents a safer and more effective pacing strategy compared to RVP.
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