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
BACKGROUND: Nonselective His-bundle pacing (nsHBp), nonselective left bundle branch pacing (nsLBBp), and left ventricular septal myocardial pacing (LVSP) are recognized as physiological pacing techniques. OBJECTIVE: The purpose of this study was to compare differences in ventricular depolarization between these techniques using ultra-high-frequency electrocardiography (UHF-ECG). METHODS: In patients with bradycardia, nsHBp, nsLBBp (confirmed concomitant left bundle branch [LBB] and myocardial capture), and LVSP (pacing in left ventricular [LV] septal position without proven LBB capture) were performed. Timings of ventricular activations in precordial leads were displayed using UHF-ECG, and electrical dyssynchrony (e-DYS) was calculated as the difference between the first and last activation. Duration of local depolarization (Vd) was determined as width of the UHF-QRS complex at 50% of its amplitude. RESULTS: In 68 patients, data were collected during nsLBBp (35), LVSP (96), and nsHBp (55). nsLBBp resulted in larger e-DYS than did LVSP and nsHBp [- 24 ms (-28;-19) vs -12 ms (-16;-9) vs 10 ms (7;14), respectively; P <.001]. nsLBBp produced similar values of Vd in leads V5-V8 (36-43 ms vs 38-43 ms; P = NS in all leads) but longer Vd in leads V1-V4 (47-59 ms vs 41-44 ms; P <.05) as nsHBp. LVSP caused prolonged Vd in leads V1-V8 compared to nsHBp and longer Vd in leads V5-V8 compared to nsLBBp (44-51 ms vs 36-43 ms; P <.05) regardless of R-wave peak time in lead V5 or QRS morphology in lead V1 present during LVSP. CONCLUSION: nslbbp preserves physiological LV depolarization but increases interventricular electrical dyssynchrony. LV lateral wall depolarization during LVSP is prolonged, but interventricular synchrony is preserved.
- MeSH
- blokáda Tawarova raménka patofyziologie terapie MeSH
- elektrokardiografie metody MeSH
- funkce levé komory srdeční fyziologie MeSH
- Hisův svazek patofyziologie MeSH
- kardiostimulace umělá metody MeSH
- lidé MeSH
- mezikomorová přepážka patofyziologie MeSH
- následné studie MeSH
- prospektivní studie MeSH
- senioři 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
- srovnávací studie MeSH
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.
- MeSH
- akční potenciály MeSH
- blokáda Tawarova raménka diagnóza patofyziologie terapie MeSH
- časové faktory MeSH
- elektrokardiografie * MeSH
- funkce levé komory srdeční MeSH
- funkce pravé komory srdeční MeSH
- Hisův svazek patofyziologie MeSH
- lidé MeSH
- ověření koncepční studie MeSH
- prediktivní hodnota testů MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- srdeční frekvence * MeSH
- srdeční resynchronizační terapie * MeSH
- srdeční selhání diagnóza patofyziologie terapie MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví 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
V níže uvedené kasuistice popisujeme případ 56letého muže s méně obvyklou EKG manifestací akcesorní neboli přídatné dráhy. V případě nesprávně stanovené diagnózy by mohl být pacient vystaven riziku náhlé srdeční smrti. Přídatná dráha lokalizovaná vlevo posteroseptálně se uvedla širokokomplexovou tachykardií, která i přesto, že šlo o preexcitovanou fibrilaci síní, mohla být nesprávně diagnostikována jako komorová tachykardie. Při změně úvodní tachykardie na sinusový rytmus se ve spodních svodech EKG objevil obraz kmitu Q, který mohl být mylně popsán jako obraz proběhlého infarktu myokardu. V tomto případě by pacient byl vystaven zahájení léčby zahrnující i léky ze skupiny beta-blokátorů, které by teoreticky zvyšovaly riziko náhlé srdeční smrti. Léčebnou metodou volby pro tohoto pacienta byla katetrová radiofrekvenční ablace přídatné dráhy.
We present the case report of a 56-year-old man with an unusual manifestation of an accessory pathway. Failure to detect, or incorrect diagnosis, of this anomaly could have put the patient at high risk of sudden cardiac death. The accessory pathway described in this case report was located at the left posteroseptal area and presented initially with a broad QRS complex tachycardia. Despite being pre-excited atrial fibrillation, it could have been misinterpreted as ventricular tachycardia. Once the rhythm had changed to sinus, a Q-wave in the inferior ECG leads became apparent. This finding could have been misdiagnosed as an old myocardial infarction and treated as such, including prescription of betablockers which might, in theory, increase the risk of sudden cardiac death. The treatment of choice for the patient was radiofrequency ablation of the accessory pathway.
- MeSH
- atrioventrikulární nodální reentry tachykardie * patofyziologie terapie ultrasonografie MeSH
- echokardiografie MeSH
- Hisův svazek * abnormality patofyziologie MeSH
- katetrizační ablace MeSH
- lidé středního věku MeSH
- lidé MeSH
- náhlá srdeční smrt prevence a kontrola MeSH
- nodus atrioventricularis * abnormality patofyziologie MeSH
- srdeční komory patofyziologie MeSH
- srdeční síně patofyziologie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
- práce podpořená grantem MeSH
This study investigated long-term outcome of catheter ablation of right anteroseptal atrio-ventricular (AV) accessory pathways (AP) located close to the His bundle. Methods Between April 2003 and June 2011, 26 patients (6 females, age 35±13 years) underwent catheter ablation of right anteroseptal AP. These APs represented 10% of all 248 APs ablated within the given reference period. Elimination of AP conduction in both directions and preservation of normal AV conduction were the ablation procedure endpoints. Results First ablation was effective in 18 (69%) patients. After repeat ablation, AP was permanently eliminated in 22 (85%) patients (one, two, and three ablation procedures in 16, 5, and 1 patient, respectively). Ablation failed in 4 patients (1 procedure in 3 patients, 2 procedures in 1 patient). During 56±27 (4–102) month follow-up period since the last ablation, no late AP conduction recovery was found, and no late advanced AV block occurred. Post-ablation AV node Wenckebach point was present at the pacing rate of 176±26 (130–230) beats per minute. Of the two engaged operators, more experienced operator successfully accomplished first, second, and third ablation procedure in 14/16 (88%), 5/5 (100%), and 1/1 (100%) patients, respectively, the latter operator attained successful ablation in 4/10 (40%) and 1/2 (50%) patients at the first and second ablation procedures, respectively. Conclusion Ablation of right anteroseptal AP close to the His bundle is feasible and safe. Late advanced AV block was not observed. Individual operator's experience influenced ablation efficacy.
- Klíčová slova
- přídatná dráha,
- MeSH
- dospělí MeSH
- Hisův svazek patofyziologie MeSH
- katetrizační ablace metody využití MeSH
- lidé středního věku MeSH
- lidé MeSH
- opakovaná terapie metody statistika a číselné údaje MeSH
- převodní systém srdeční patologie MeSH
- srdeční arytmie terapie MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- MeSH
- angioplastika MeSH
- aortální chlopeň patofyziologie MeSH
- aortální stenóza patofyziologie terapie MeSH
- dysfunkce levé srdeční komory patofyziologie terapie MeSH
- echokardiografie MeSH
- elektrokardiografie MeSH
- Hisův svazek abnormality patofyziologie ultrasonografie MeSH
- implantované elektrody MeSH
- lidé MeSH
- senioři nad 80 let MeSH
- srdeční chlopně umělé MeSH
- srdeční resynchronizační terapie MeSH
- tepový objem fyziologie MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
- práce podpořená grantem MeSH
- MeSH
- dospělí MeSH
- elektrokardiografie MeSH
- Hisův svazek patofyziologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- převodní systém srdeční MeSH
- senioři MeSH
- srdeční arytmie diagnóza MeSH
- synkopa etiologie MeSH
- tachykardie diagnóza MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- MeSH
- ablace * metody normy trendy MeSH
- Hisův svazek * fyziologie patofyziologie MeSH
- hodnocení biomedicínských technologií MeSH
- klinické zkoušky jako téma MeSH
- lidé MeSH
- nodus sinuatrialis chirurgie inervace účinky léků MeSH
- srdeční arytmie diagnóza terapie MeSH
- srdeční katetrizace metody normy trendy MeSH
- srdeční selhání diagnóza etiologie terapie MeSH
- statistika jako téma MeSH
- supraventrikulární tachykardie * diagnóza komplikace terapie MeSH
- synkopa MeSH
- výsledky a postupy - zhodnocení (zdravotní péče) MeSH
- Check Tag
- lidé MeSH
