Search

Introduction: We aimed to compare the acute differences in left ventricular (LV) function and mechanical synchrony during nonselective His bundle pacing (ns‐HBP) versus selective His bundle pacing (s‐HBP) using strain echocardiography. Methods and results: Consecutive patients with permanent His bundle pacing, in whom it was possible to obtain both s‐HBP and ns‐HBP, were studied in two centers. In each patient, echocardiography was performed sequentially during s‐HBP and ns‐HBP. Speckle‐tracking echocardiography parameters were analyzed: Global longitudinal strain (GLS), the time delay between peak systolic strain in the basal septal and basal lateral segments (BS‐BL delay), peak strain dispersion (PSD) and strain delay index. Right ventricle function was assessed using tricuspid annular plane systolic excursion (TAPSE) and tissue Doppler velocity of the lateral tricuspid annulus (S′). A total of 69 patients (age: 75.6 ± 10.5 years; males: 75%) were enrolled. There were no differences in LV ejection fraction and GLS between s‐HBP and ns‐HBP modes: 59% versus 60%, and −15.6% versus −15.7%, respectively; as well as no difference in BS‐BL delay and strain delay index. The PSD value was higher in the ns‐HBP group than in the s‐HBP group with the most pronounced difference in the basal LV segments. No differences in right ventricular function parameters (TAPSE and S′) were found. Conclusion: The ns‐HBP and s‐HBP modes seem comparable regarding ventricular function. The dyssynchrony parameters were significantly higher during ns‐HBP, however, the difference seems modest and clarification of its impact on LV function requires a larger long‐term study. [ABSTRACT FROM AUTHOR]

Introduction: The present study introduces a new ultra-high-frequency 14-lead electrocardiogram technique (UHF-ECG) for mapping ventricular depolarization patterns and calculation of novel dyssynchrony parameters that may improve the selection of patients and application of cardiac resynchronization therapy (CRT)., Methods: Components of the ECG in sixteen frequency bands within the 150 to 1000 Hz range were used to create ventricular depolarization maps. The maximum time difference between the UHF QRS complex centers of mass of leads V1 to V8 was defined as ventricular electrical dyssynchrony (e-DYS), and the duration at 50% of peak voltage amplitude in each lead was defined as the duration of local depolarization (Vd). Proof of principle measurements was performed in seven patients with left (left bundle branch block) and four patients with right bundle branch block (right bundle branch block) before and during CRT using biventricular and His-bundle pacing., Results: The acquired activation maps reflect the activation sequence under the tested conditions. e-DYS decreased considerably more than QRS duration, during both biventricular pacing (-50% vs -8%) and His-bundle pacing (-77% vs -13%). While biventricular pacing slightly increased Vd, His-bundle pacing reduced Vd significantly (+11% vs -36%), indicating the contribution of the fast conduction system. Optimization of biventricular pacing by adjusting VV-interval showed a decrease of e-DYS from 102 to 36 ms with only a small Vd increase and QRS duration decrease., Conclusions: The UHF-ECG technique provides novel information about electrical activation of the ventricles from a standard ECG electrode setup, potentially improving the selection of patients for CRT and application of CRT., (© 2019 Wiley Periodicals, Inc.)