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Journal of Innovations in Cardiac Rhythm Management
Article . 2021 . Peer-reviewed
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Effect of Nonselective His Bundle Pacing on Delayed Myocardial Activation in Left-axis Deviation and Left Bundle Branch Block

Authors: Stacey Kukla; Brenda Harris; Shakeel Jamal; Rehan Mahmud;

Effect of Nonselective His Bundle Pacing on Delayed Myocardial Activation in Left-axis Deviation and Left Bundle Branch Block

Abstract

It has been suggested that nonselective His bundle pacing (NS-HBP) corrects terminal conduction delay in right bundle branch block by early excitation of the right ventricular free wall. A similar analysis of NS-HBP, in patients with left bundle branch block (LBBB) and left-axis deviation (LAD) has not been done. Therefore, we compared the baseline QRS parameters in LAD and LBBB during NS-HBP and selective HBP (S-HBP). In LAD patients (n = 16), NS-HBP normalized the QRS axis from -35° ± 10° to 30° ± 34° (p < 0.01) and increased the lead 1 voltage (L1V) from 0.55 ± 0.3 mV to 0.88 ± 0.2 mV (p < 0.001) without increasing the peak lateral wall activation time (PLWAT) (p = not significant). In 23 of 41 LBBB patients, NS-HBP decreased the prolonged PLWAT by 73 ms (p < 0.0001), resolved the mid-QRS notch, normalized the QRS axis, and increased the L1V from 0.5 ± 0.3 mV to 1.15 ± 0.3 mV (p < 0.0001). In the remaining 18 LBBB patients, NS-HBP did not resolve the mid-QRS notch; however, the peak septal activation time decreased by 45 ms (p < 0.0001), PLWAT decreased by 53 ms (p < 0.0001), L1V increased from 0.5 ± 0.3 mV to 0.87 ± 0.4 mV (p < 0.0001), and the QRS axis normalized. All patients who developed S-HBP at lower pacing showed uncorrected LBBB (n = 6) or LAD (n = 7). In conclusion, NS-HBP, which causes myocardial activation in advance of simultaneously initiated S-HBP, results in a paced QRS complex with a normal axis and shorter activation times and restores the L1V in patients with LAD and LBBB. In some patients, a mid-QRS notch was seen with NS-HBP, which suggests fusion with S-HBP, which conducts without LBBB correction. A higher L1V in association with a shorter PLWAT and a normal QRS axis suggests that a more organized degree of left ventricular activation occurs with NS-HBP as compared to LBBB.

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    Top 10%
    influence
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citations
This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Citations provided by BIP!
popularity
This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.
BIP!Popularity provided by BIP!
influence
This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Influence provided by BIP!
impulse
This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
BIP!Impulse provided by BIP!
5
Top 10%
Average
Average
Green
gold