Hemodynamic Doppler echocardiographic evaluation of permanent His bundle and biventricular pacing after AV nodal
Robert H Hoyt1, Brian P Kelley1, Mark J Harry1
1Iowa Heart Center, West Des Moines, Iowa. Dr. Kelley is affiliated with Des Moines University of Osteopathic Medicine, Iowa.
Insights
His bundle pacing (HBP) and biventricular pacing (BVP) significantly improve cardiac function after AV nodal ablation compared to right ventricular apical pacing (RVAP). HBP demonstrated broader benefits across all measured hemodynamic parameters.
Area of Science:
- Cardiology
- Electrophysiology
- Cardiac Pacing
Background:
- Atrial fibrillation (AF) management often involves atrioventricular (AV) nodal ablation.
- Post-ablation pacing strategies include His bundle pacing (HBP), biventricular pacing (BVP), and right ventricular apical pacing (RVAP).
- Optimizing hemodynamic outcomes after AV nodal ablation is crucial for patient well-being.
Purpose of the Study:
- To compare the hemodynamic effects of HBP, BVP, and RVAP after AV nodal ablation.
- To evaluate left ventricular (LV) hemodynamics using Doppler echocardiography.
- To determine the relationship between different pacing methods and hemodynamic performance.
Main Methods:
- Doppler echocardiography was employed to assess LV hemodynamics in 20 patients.
- Patients underwent AV nodal ablation and received either HBP, BVP, or RVAP.
- Key parameters measured included LV dP/dt, LV pre-ejection interval, and myocardial performance index relative to RVAP.
Main Results:
- Both HBP and BVP showed a significant improvement in LV dP/dt (>17%) compared to RVAP.
- HBP demonstrated improvement across all three assessed hemodynamic parameters.
- BVP also showed hemodynamic superiority over RVAP, though not across all parameters.
Conclusions:
- HBP effectively provides LV electromechanical synchrony, as evidenced by multiple echo Doppler parameters.
- Both HBP and BVP represent hemodynamically superior pacing options compared to RVAP following AV nodal ablation.
- These findings support HBP and BVP as beneficial pacing strategies in patients with permanent AF post-ablation.
Abstract:
placing after atrioventricular (AV) nodal ablation for permanent atrial fibrillation (AF) may include cardiac resynchronization therapy (CRT) with either His bundle pacing (HBP) or biventricular pacing (BVP), or conventional single site right ventricular apical pacing (RVAP). To determine the relationship between pacing method and hemodynamic outcome, we used Doppler echocardiographic methods to evaluate left ventricular (LV) hemodynamics after AV nodal ablation and either HBP, BVP, or RVAP.
Method:
20 patients were evaluated > 6 months after AV nodal ablation, 10 each with chronic HBP or BVP, and all with RVAP lead. Doppler echocardiography was used to measure 3 parameters indicative of CRT: 1) LV dP/dt, 2) the LV pre-ejection interval, and 3) myocardial performance index, relative to intra-patient RVAP.
Results:
Primary endpoint of LV dP/dt on average improved by > 17% with both HBP and BVP, compared to RVAP. HBP but not BVP, had improvement across all three parameters.
Conclusion:
HBP provides LV electromechanical synchrony across multiple echo Doppler parameters. Both HBP and BVP were hemodynamically superior to RVAP following AV nodal ablation.
