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Journal of Electrocardiology
Article . 2021 . Peer-reviewed
License: CC BY NC ND
Data sources: Crossref
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Journal of Electrocardiology
Article
License: CC BY NC ND
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Effect of His bundle pacing on right bundle branch block located distal to site of pacing

Authors: Shakeel Jamal; Rehan Mahmud;

Effect of His bundle pacing on right bundle branch block located distal to site of pacing

Abstract

It is generally accepted that bundle branch block (BBB) may be corrected simply by selective His bundle pacing (S-HBP) distal to site of block. However, clinical HBP is often non-selective (NS), the site of block unknown and moving the HB lead is not always an option. Thus, while correction of right (R) BBB in NS-HBP has been reported, its mechanism is unknown.Threshold testing was done during His bundle pacing in 39 patients with RBBB. We compared NS-HBP and S-HBP and analyzed the role of pacing voltage and capture threshold of the parallel pathway, in partially or completely correcting RBBB.During NS-HBP, higher pacing voltage completely corrected RBBB in 22/35 patients as compared to 5/18 patients at lower voltage. Remaining patients showed incomplete correction of RBBB. NS-HBP group with lower capture threshold of 1.3 ± 0.5 V completely resolved RBBB in 9/14 vs 3/11 patients in NS-S HBP group with higher capture threshold of 2.4 ± 0.8 V. QRS activation time in NSHBP was 91 ± 8 ms (baseline 97 ± 7 ms p = ns). S-HBP resolved RBBB in only 1/21 patients.1.) Lack of correction with S-HBP suggests that RBBB was distal to site of HBP and yet was corrected with NS-HBP. 2.) Voltage dependent correction of RBBB in NS-HBP suggests that conduction via a specialized parallel pathway maintains normal ventricular activation time. 3.) Correction of RBBB in all patients with NS-HBP, suggests that conduction block was either bypassed or right ventricular free wall pre-excited by conduction via parallel pathway.

Keywords

Bundle of His, Electrocardiography, Treatment Outcome, Bundle-Branch Block, Cardiac Pacing, Artificial, Humans

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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!
10
Top 10%
Average
Top 10%
hybrid