His bundle pacing is a relatively new method of cardiac pacing. This method is used in patients with atrioventricular block to prevent heart failure associated with right ventricular pacing, and in patients with bundle branch block and cardiomyopathy. We report a patient with cardiomyopathy and left bundle branch block with failure of cardiac resynchronization therapy. Permanent His bundle pacing was associated with clinical improvement and improvement of parameters of cardiac function.

• MeSH
• blokáda Tawarova raménka diagnóza   etiologie   patofyziologie   chirurgie   MeSH
• dilatační kardiomyopatie komplikace   diagnóza   patofyziologie   chirurgie   MeSH
• elektrokardiografie MeSH
• funkce levé komory srdeční fyziologie   MeSH
• Hisův svazek fyziologie   MeSH
• implantované elektrody MeSH
• kardiostimulace umělá metody   MeSH
• kardiostimulátor MeSH
• lidé MeSH
• senioři MeSH
• srdeční katetrizace přístrojové vybavení   metody   MeSH
• srdeční resynchronizační terapie škodlivé účinky   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

Chronická unifokální pravokomorová stimulace může vést k dyssynchronii kontrakcí levé komory srdeční a její následné dysfunkci s rozvojem projevů srdečního selhání. Jeho vznik byl klasicky spojován se stimulací v oblasti hrotu pravé komory srdeční, a to zejména u pacientů s vysokým procentem pravokomorové stimulace. V posledních dvou dekádách bylo věnováno velké úsilí nalezení alternativního místa pro trvalou kardiostimulaci, které by riziko srdečního selhání snížilo či mu zabránilo. Podle posledních poznatků se zdá, že toho je možné dosáhnout pomocí stimulace oblasti Hisova svazku. V naší kazuistice prezentujeme 79letého pacienta, u kterého došlo do šesti měsíců po implantaci stimulační elektrody do oblasti septa pravé komory k rozvoji srdečního selhání pro nově vzniklou těžkou dysfunkci levé komory srdeční. U pacienta byla indikována resynchronizační terapie a byl mu implantován kardioverter-defi brilátor se stimulační elektrodou umístěnou do oblasti Hisova svazku. Selektivní stimulace Hisova svazku vedla k normalizaci trvání komplexu QRS a razantnímu zlepšení symptomů pacienta. Při klinické a echokardiografi cké kontrole za tři měsíce trval příznivý klinický efekt zvoleného způsobu stimulace a došlo k normalizaci funkce LKS.

Permanent unifocal right ventricular pacing can lead to ventricular dyssynchrony with subsequent dysfunction of the left ventricle, which can lead to heart failure. Heart failure caused by right ventricular pacing was traditionally associated with pacing from the apex of the right ventricle. Over the last two decades, signifi cant efforts have been made to fi nd alternative pacing sites that can reduce or prevent the risk of heart failure. Based on the latest fi ndings, pacing the His bundle area appears extremely promising. In this case report, we present a 79-year-old male, who developed left ventricular dysfunction with heart failure within six months of right ventricular septal pacing. The patient was upgraded to CRT-D, and one of the pacing leads was implanted in the His bundle area. Selective His bundle pacing led to normalization of QRS duration and a signifi cant improvement of heart failure symptoms. Echocardiography performed after three months showed normalized left ventricular function.

• Klíčová slova
• stimulace hisova svazku, resynchronizační terapie,
• MeSH
• elektrická stimulace MeSH
• Hisův svazek MeSH
• kardiostimulátor škodlivé účinky   MeSH
• lidé MeSH
• převodní systém srdeční patologie   MeSH
• senioři MeSH
• srdeční arytmie * diagnóza   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH

BACKGROUND: Adoption and outcomes for conduction system pacing (CSP), which includes His bundle pacing (HBP) or left bundle branch area pacing (LBBAP), in real-world settings are incompletely understood. We sought to describe real-world adoption of CSP lead implantation and subsequent outcomes. METHODS: We performed an online cross-sectional survey on the implantation and outcomes associated with CSP, between November 15, 2020, and February 15, 2021. We described survey responses and reported HBP and LBBAP outcomes for bradycardia pacing and cardiac resynchronization CRT indications, separately. RESULTS: The analysis cohort included 140 institutions, located on 5 continents, who contributed data to the worldwide survey on CSP. Of these, 127 institutions (90.7%) reported experience implanting CSP leads. CSP and overall device implantation volumes were reported by 84 institutions. In 2019, the median proportion of device implants with CSP, HBP, and/or LBBAP leads attempted were 4.4% (interquartile range [IQR], 1.9-12.5%; range, 0.4-100%), 3.3% (IQR, 1.3-7.1%; range, 0.2-87.0%), and 2.5% (IQR, 0.5-24.0%; range, 0.1-55.6%), respectively. For bradycardia pacing indications, HBP leads, as compared to LBBAP leads, had higher reported implant threshold (median [IQR]: 1.5 V [1.3-2.0 V] vs 0.8 V [0.6-1.0 V], p = 0.0008) and lower ventricular sensing (median [IQR]: 4.0 mV [3.0-5.0 mV] vs. 10.0 mV [7.0-12.0 mV], p < 0.0001). CONCLUSION: In conclusion, CSP lead implantation has been broadly adopted but has yet to become the default approach at most surveyed institutions. As the indications and data for CSP continue to evolve, strategies to educate and promote CSP lead implantation at institutions without CSP lead implantation experience would be necessary.

• MeSH
• bradykardie * terapie   MeSH
• elektrokardiografie MeSH
• Hisův svazek * MeSH
• kardiostimulace umělá MeSH
• lidé MeSH
• nemoci převodního systému srdečního MeSH
• převodní systém srdeční MeSH
• průřezové studie MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

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.

• MeSH
• dysfunkce pravé srdeční komory patofyziologie   terapie   MeSH
• Hisův svazek patofyziologie   MeSH
• kardiostimulace umělá metody   MeSH
• kardiostimulátor * MeSH
• lidé MeSH
• senioři MeSH
• tepový objem MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

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.

• MeSH
• echokardiografie MeSH
• funkce pravé komory srdeční MeSH
• Hisův svazek * diagnostické zobrazování   MeSH
• kardiostimulace umělá * MeSH
• lidé MeSH
• senioři MeSH
• tepový objem MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

BACKGROUND: Right ventricular myocardial pacing leads to nonphysiological activation of heart ventricles. Contrary to this, His bundle pacing preserves their fast activation. Ultra-high-frequency electrocardiography (UHF-ECG) is a novel tool for ventricular depolarization assessment. OBJECTIVE: The purpose of this study was to describe UHF-ECG depolarization patterns during myocardial and His bundle pacing. METHODS: Forty-six patients undergoing His bundle pacing to treat bradycardia and spontaneous QRS complexes without bundle branch block were included. UHF-ECG recordings were performed during spontaneous rhythm, pure myocardial para-Hisian capture, and His bundle capture. QRS duration, QRS area, depolarization time in specific leads, and the UHF-ECG-derived ventricular dyssynchrony index were calculated. RESULTS: One hundred thirty-three UHF-ECG recordings were performed in 46 patients (44 spontaneous rhythm, 28 selective His bundle, 43 nonselective His bundle, and 18 myocardial capture). The mean QRS duration was 117 ms for spontaneous rhythm, 118 ms for selective, 135 ms for nonselective, and 166 ms for myocardial capture (P < .001 for nonselective and myocardial capture compared to each of the other types of ventricular activation). The calculated dyssynchrony index was shortest during spontaneous rhythm (12 ms; P = .02 compared to selective and P = .09 compared to nonselective), and it did not differ between selective and nonselective His bundle capture (16 vs 15 ms; P > .99) and was longest during myocardial capture of the para-Hisian area (37 ms; P < .001 compared to each of the other types of ventricular activation). CONCLUSION: In patients without bundle branch block, both types of His bundle, but not myocardial, capture preserve ventricular electrical synchrony as measured using UHF-ECG.

• MeSH
• blokáda Tawarova raménka patofyziologie   terapie   MeSH
• elektrokardiografie metody   MeSH
• funkce levé komory srdeční fyziologie   MeSH
• funkce pravé komory srdeční fyziologie   MeSH
• Hisův svazek patofyziologie   MeSH
• kardiostimulace umělá metody   MeSH
• lidé MeSH
• senioři MeSH
• srdeční frekvence fyziologie   MeSH
• srdeční komory patofyziologie   MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

AIMS: Permanent His-bundle (HB) pacing is usually accompanied by simultaneous capture of the adjacent right ventricular (RV) myocardium-this is described as a non-selective (ns)-HB pacing. It is of clinical importance to confirm HB capture using standard electrocardiogram (ECG). Our aim was to identify ECG criteria for loss of HB capture during ns-HB pacing. METHODS AND RESULTS: Patients with permanent HB pacing were recruited. Electrocardiograms during ns-HB pacing and loss of HB capture (RV-only capture) were obtained. Electrocardiogram criteria for loss/presence of HB capture were identified. In the validation phase, these criteria and the 'HB ECG algorithm' were tested using a separate, sizable set of ECGs. A total of 353 ECG (226 ns-HB and 128 RV-only) were obtained from 226 patients with permanent HB pacing devices. QRS notch/slur in left ventricular leads and R-wave peak time (RWPT) in lead V6 were identified as the best features for differentiation. The 'HB ECG algorithm' based on these features correctly classified 87.1% of cases with sensitivity and specificity of 93.2% and 83.9%, respectively. The criteria for definitive diagnosis of ns-HB capture (no QRS slur/notch in Leads I, V1, V4-V6, and the V6 RWPT ≤ 100 ms) presented 100% specificity. CONCLUSION: A novel ECG algorithm for the diagnosis of loss of HB capture and criteria for definitive confirmation of HB capture were formulated and validated. The algorithm might be useful during follow-up and the criteria for definitive confirmation of ns-HB capture offer a simple and reliable ancillary procedural endpoint during HB device implantation.

• MeSH
• algoritmy * MeSH
• atrioventrikulární blokáda terapie   MeSH
• elektrokardiografie metody   MeSH
• fibrilace síní terapie   MeSH
• Hisův svazek * MeSH
• kardiostimulace umělá * MeSH
• lidé středního věku MeSH
• lidé MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• srdeční selhání terapie   MeSH
• syndrom chorého sinu terapie   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• validační studie MeSH

• MeSH
• atrioventrikulární blokáda komplikace   diagnóza   terapie   MeSH
• elektrokardiografie * MeSH
• Hisův svazek MeSH
• infarkt myokardu komplikace   diagnostické zobrazování   chirurgie   MeSH
• kardiostimulace umělá * MeSH
• koronární angiografie MeSH
• koronární angioplastika * MeSH
• lidé MeSH
• senioři nad 80 let MeSH
• Check Tag
• lidé MeSH
• senioři nad 80 let MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

• MeSH
• blokáda Tawarova raménka etiologie   terapie   MeSH
• elektrokardiografie MeSH
• funkce levé komory srdeční MeSH
• Hisův svazek * MeSH
• kardiomyopatie * etiologie   terapie   MeSH
• kardiostimulace umělá škodlivé účinky   MeSH
• lidé MeSH
• srdeční komory MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

BACKGROUND: Targets for right-sided conduction system pacing (CSP) include His bundle and right bundle branch. Electrocardiographic patterns, diagnostic criteria, and outcomes of right bundle branch pacing (RBBP) are not known. OBJECTIVE: Our aims were to delineate electrocardiographic and electrophysiological characteristics of RBBP and to compare outcomes between RBBP and His bundle pacing (HBP). METHODS: Patients with confirmed right CSP were divided according to the conduction system potential to QRS complex interval at the pacing lead implantation site. Six hypothesized RBBP criteria as well as pacing parameters, echocardiographic outcomes, and all-cause mortality were analyzed. RESULTS: All analyzed criteria discriminated between HBP and RBBP: double QRS complex transition during the threshold test, selective paced QRS complex different from conducted QRS complex, stimulus to selective-QRS complex > potential-QRS complex, small increase in V6 R-wave peak time (V6RWPT) during QRS complex transition, equal capture thresholds of CSP and myocardium, and stimulus-V6RWPT > potential-V6RWPT (adopted as the diagnostic standard). According to the last criterion, RBBP was observed in 19.2% of patients (64 of 326) who had been targeted for HBP, present mainly among patients with potential to QRS complex interval <35 ms (90.6% [48 of 53]) and occasionally among the remaining patients (5.6% [16 of 273]). RBBP was characterized by longer QRS complex (by 10.5 ms), longer V6RWPT (by 11.6 ms), and better sensing (by 2.6 mV) compared with HBP. During a median follow-up duration of 29 months, no differences in capture threshold, echocardiographic outcomes, or mortality were found. CONCLUSION: RBBP has distinct features that separate it from HBP and is observed in approximately a fifth of patients in whom HBP is intended.

• MeSH
• echokardiografie MeSH
• elektrokardiografie MeSH
• Hisův svazek MeSH
• kardiostimulace umělá * MeSH
• lidé MeSH
• nemoci převodního systému srdečního MeSH
• převodní systém srdeční * MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH