Impact of His bundle pacing on right ventricular performance in patients undergoing permanent pacemaker implantation. Issue 6 (7th May 2021)

• Record Type: Journal Article
• Authors: Grieco, Domenico; Bressi, Edoardo; Curila, Karol; Padala, Santosh K.; Sedlacek, Kamil; Kron, Jordana; Fedele, Elisa; Ionita, Oana; Giannuzzi, Sara; Fagagnini, Alessandro; Panattoni, Germana; De Ruvo, Ermenegildo; Ellenbogen, Kenneth A.; Calò, Leonardo
• Is Part Of: Pacing and clinical electrophysiology. Volume 44:Issue 6(2021)
• Page Start: 986
• Page End: 994
• Publication Date: 2021-05-07
• Subjects: conduction system pacing -- echocardiogram -- His‐Bundle pacing -- pacemaker -- right ventricle; Cardiac pacing -- Periodicals; Electrophysiology -- Periodicals; 617.4120645
• DOI: 10.1111/pace.14249
• Languages: English
• ISSNs: 0147-8389

Abstract

Abstract: Background: His‐Bundle pacing (HBP) is an emerging technique for physiological pacing. However, its effects on right ventricle (RV) performance are still unknown. Methods: We enrolled consecutive patients with an indication for pacemaker (PM) implantation to compare HBP versus RV pacing (RVP) effects on RV performance. Patients were evaluated before implantation and after 6 months by a transthoracic echocardiogram. Results: A total of 84 patients (age 75.1±7.9 years, 64% male) were enrolled, 42 patients (50%) underwent successful HBP, and 42 patients (50%) apical RVP. At follow up, we found a significant improvement in RV‐FAC (Fractional Area Change)% [baseline: HBP 34 IQR (31–37) vs. RVP 33 IQR (29.7–37.2), p = .602; 6‐months: HBP 37 IQR (33–39) vs. RVP 30 IQR (27.7–35), p < .0001] and RV‐GLS (Global Longitudinal Strain)% [baseline: HBP –18 IQR (–20.2 to –15) vs. RVP –16 IQR (–18.7 to –14), p = .150; 6‐months: HBP –20 IQR(–23 to –17) vs. RVP –13.5 IQR (–16 to –11), p < .0001] with HBP whereas RVP was associated with a significant decline in both parameters. RVP was also associated with a significant worsening of tricuspid annular plane systolic excursion (TAPSE) ( p < .0001) and S wave velocity ( p < .0001) at follow up. Conversely from RVP, HBP significantly improved pulmonary artery systolic pressure (PASP) [baseline: HBP 38 IQR (32–42) mmHg vs. RVP 34 IQR (31.5–37) mmHg, p = .060; 6‐months: HBP 32 IQR (26–38) mmHg vs. RVP 39 IQR (36–41) mmHg, p < .0001] and tricuspid regurgitation ( p = .005) irrespectively from lead position above or below the tricuspid valve. Conclusions: In patients undergoing PM implantation, HBP ensues a beneficial and protective impact on RV performance compared with RVP.