- 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: Right ventricular pacing (RVP) can result in pacing-induced cardiomyopathy (PICM). It is unknown whether specific biomarkers reflect differences between His bundle pacing (HBP) and RVP and predict a decrease in left ventricular function during RVP. AIMS: We aimed to compare the effect of HBP and RVP on the left ventricular ejection fraction (LVEF) and to study how they affect serum markers of collagen metabolism. METHODS: Ninety-two high-risk PICM patients were randomized to HBP or RVP groups. Their clinical characteristics, echocardiography, and serum levels of transforming growth factor β1 (TGF-β1), matrix metalloproteinase 9 (MMP-9), suppression of tumorigenicity 2 interleukin (ST2-IL), tissue inhibitor of metalloproteinase 1 (TIMP-1), and galectin 3 (Gal-3) were studied before pacemaker implantation and six months later. RESULTS: Fifty-three patients were randomized to the HBP group and 39 patients to the RVP group. HBP failed in 10 patients, who crossed over to the RVP group. Patients with RVP had significantly lower LVEF compared to HBP patients after six months of pacing (-5% and -4% in as-treated and intention-to-treat analysis, respectively). Levels of TGF-β1 after 6 months were lower in HBP than RVP patients (mean difference -6 ng/ml; P = 0.009) and preimplant Gal-3 and ST2-IL levels were higher in RVP patients, with a decline in LVEF ≥5% compared to those with a decline of <5% (mean difference 3 ng/ml and 8 ng/ml; P = 0.02 for both groups). CONCLUSION: In high-risk PICM patients, HBP was superior to RVP in providing more physiological ventricular function, as reflected by higher LVEF and lower levels of TGF-β1. In RVP patients, LVEF declined more in those with higher baseline Gal-3 and ST2-IL levels than in those with lower levels.
- MeSH
- biologické markery MeSH
- elektrokardiografie MeSH
- funkce levé komory srdeční * fyziologie MeSH
- Hisův svazek MeSH
- interleukin-1 receptor-like 1 protein MeSH
- kardiomyopatie * MeSH
- kardiostimulace umělá škodlivé účinky MeSH
- kolagen MeSH
- lidé MeSH
- tepový objem fyziologie MeSH
- tkáňový inhibitor metaloproteinasy 1 MeSH
- transformující růstový faktor beta1 MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- randomizované kontrolované studie MeSH
The majority of patients tolerate right ventricular pacing well; however, some patients manifest signs of heart failure after pacemaker implantation and develop pacing-induced cardiomyopathy. This is a consequence of non-physiological ventricular activation bypassing the conduction system. Ventricular dyssynchrony was identified as one of the main factors responsible for pacing-induced cardiomyopathy development. Currently, methods that would allow rapid and reliable ventricular dyssynchrony assessment, ideally during the implant procedure, are lacking. Paced QRS duration is an imperfect marker of dyssynchrony, and methods based on body surface mapping, electrocardiographic imaging or echocardiography are laborious and time-consuming, and can be difficult to use during the implantation procedure. However, the ventricular activation sequence can be readily displayed from the chest leads using an ultra-high-frequency ECG. It can be performed during the implantation procedure to visualise ventricular depolarisation and resultant ventricular dyssynchrony during pacing. This information can assist the electrophysiologist in selecting a pacing location that avoids dyssynchronous ventricular activation.
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
Souhrn: Stimulace oblasti levého Tawarova raménka (LBBAP) je nový způsob stimulace u nemocných s bradykardií či indikací k resynchronizační terapii (CRT). Údajů o peroperačních a pooperačních výsledcích této metody je nedostatek. Metody: Do registru byli zařazeni všichni nemocní s bradykardií nebo indikací k CRT, u kterých byla v období 11/2018-5/2021 v průběhu operačního zákroku prováděna LBBAP v Kardiocentru FNKV a 3. LF UK. Většina pacientů byla do registru zařazena prospektivně a vybrané ukazatele byly doplňovány retrospektivně. Ke shromáždění základních klinických, peroperačních a pooperačních ukazatelů byly použity údaje z elektronického nemocničního infomačního systému a elektrofyziologického zařízení používaného v průběhu operačních zákroků. Výsledky: LBBAP byla prováděna u 329 pacientů, z toho se jednalo o 237 nemocných s bradykardií a 92 nemocných se CRT indikací. Stimulační prahy k dosažení LBBAP byly průměrně 0,6 ± 0,5V na 0,5 ms a při průměrné délce sledování 5 ± 5 měsíců byly stabilní (0,7 ± 0,3V na 0,4 ms). Komplikace byly pozorovány u 26 pacientů (8 %), z toho se u 15 z nich jednalo o komplikace specifické pro LBBAP (12× peroperační penetrace elektrody do dutiny LKS, 1× bolest na hrudi a 1× bolest na hrudi s elevacemi ST úseků po fixaci elektrody), které však odezněly bez následků ještě v průběhu zákroku. Celková úspěšnost LBBAP byla 89 % a byla signifikantně vyšší u pacientů s bradykardií, než u pacientů se CRT indikací (92 % vs. 83 %, p = 0,02). Byl pozorován významný vliv počtu provedených zákroků na úspěšnost LBBAP a výskyt některých komplikací. Závěr: LBBAP je možnou alternativou trvalé kardiostimulace u pacientů s bradykardií a indikací k CRT. Vyskytují se u ní některé specifické komplikace, jejichž význam je potřeba posoudit v kontextu benefitu metody v randomizovaných studiích.
Summary: Left bundle branch area pacing (LBBAP) is a new method of pacing in patients who have bradycardia or are indicated to receive cardiac resynchronization therapy (CRT). Data on intraoperative and postoperative outcomes of this method are lacking. Methods: All patients with bradycardia or an indication for CRT, who underwent LBBAP during a surgical procedure at the Heart Centre of the Kralovske Vinohrady University Hospital and the Third Faculty of Medicine of Charles University in the period from 11/2018 to 05/2021, were included in the registry. Most patients were included in the registry in a prospective manner, and selected parameters were added retrospectively. To obtain basic clinical, intraoperative, and postoperative parameters, data from the electronic hospital information system and the electrophysiological device employed during the course of surgical procedures were used. Results: LBBAP was performed in 329 patients, of which 237 had bradycardia and 92 were indicated to receive CRT. The pacing thresholds for achieving LBBAP were 0.6 ± 0.5 V per 0.5 ms on average, and were stable with a mean follow-up duration of 5 ± 5 months (0.7 ± 0.3 V per 0.4 ms). Complications were seen in 26 patients (8%), of which 15 were specific complications related to LBBAP (12 cases of intraoperative lead penetration into the right ventricle, 1 case of chest pain, and 1 case of chest pain with ST segment elevation after lead placement) which, however, resolved without sequelae during the course of the procedure. The overall success rate of LBBAP was 89% and was significantly higher in patients with bradycardia than in those indicated to receive CRT (92% vs 83%, p = 0.02). A significant effect of the number of procedures performed on the success rate of LBBAP and the rate of some complications was observed. Conclusion: LBBAP is a possible alternative to permanent cardiac pacing in patients who have bradycardia or are indicated to receive CRT. It is associated with certain specific complications, whose significance requires evaluation in terms of the method's benefit in randomized trials.
Background: Three different ventricular capture types are observed during left bundle branch pacing (LBBp). They are selective LBB pacing (sLBBp), non-selective LBB pacing (nsLBBp), and myocardial left septal pacing transiting from nsLBBp while decreasing the pacing output (LVSP). Study aimed to compare differences in ventricular depolarization between these captures using ultra-high-frequency electrocardiography (UHF-ECG). Methods: Using decremental pacing voltage output, we identified and studied nsLBBp, sLBBp, and LVSP in patients with bradycardia. Timing of ventricular activations in precordial leads was displayed using UHF-ECGs, and electrical dyssynchrony (e-DYS) was calculated as the difference between the first and last activation. The durations of local depolarizations (Vd) were determined as the width of the UHF-QRS complex at 50% of its amplitude. Results: In 57 consecutive patients, data were collected during nsLBBp (n = 57), LVSP (n = 34), and sLBBp (n = 23). Interventricular dyssynchrony (e-DYS) was significantly lower during LVSP -16 ms (-21; -11), than nsLBBp -24 ms (-28; -20) and sLBBp -31 ms (-36; -25). LVSP had the same V1d-V8d as nsLBBp and sLBBp except for V3d, which during LVSP was shorter than sLBBp; the mean difference -9 ms (-16; -1), p = 0.01. LVSP caused less interventricular dyssynchrony and the same or better local depolarization durations than nsLBBp and sLBBp irrespective of QRS morphology during spontaneous rhythm or paced QRS axis. Conclusions: In patients with bradycardia, LVSP in close proximity to LBB resulted in better interventricular synchrony than nsLBBp and sLBBp and did not significantly prolong depolarization of the left ventricular lateral wall.
- Publikační typ
- časopisecké články MeSH
BACKGROUND: Right ventricular (RV) pacing causes delayed activation of remote ventricular segments. We used the ultra-high-frequency ECG (UHF-ECG) to describe ventricular depolarization when pacing different RV locations. METHODS: In 51 patients, temporary pacing was performed at the RV septum (mSp); further subclassified as right ventricular inflow tract (RVIT) and right ventricular outflow tract (RVOT) for septal inflow and outflow positions (below or above the plane of His bundle in right anterior oblique), apex, anterior lateral wall, and at the basal RV septum with nonselective His bundle or RBB capture (nsHBorRBBp). The timings of UHF-ECG electrical activations were quantified as left ventricular lateral wall delay (LVLWd; V8 activation delay) and RV lateral wall delay (RVLWd; V1 activation delay). RESULTS: The LVLWd was shortest for nsHBorRBBp (11 ms [95% confidence interval = 5-17]), followed by the RVIT (19 ms [11-26]) and the RVOT (33 ms [27-40]; p < .01 between all of them), although the QRSd for the latter two were the same (153 ms (148-158) vs. 153 ms (148-158); p = .99). RV apical capture not only had a longer LVLWd (34 ms (26-43) compared to mSp (27 ms (20-34), p < .05), but its RVLWd (17 ms (9-25) was also the longest compared to other RV pacing sites (mean values for nsHBorRBBp, mSp, anterior and lateral wall captures being below 6 ms), p < .001 compared to each of them. CONCLUSION: RVIT pacing produces better ventricular synchrony compared to other RV pacing locations with myocardial capture. However, UHF-ECG ventricular dysynchrony seen during RVIT pacing is increased compared to concomitant capture of basal septal myocytes and His bundle or proximal right bundle branch.
