Acute echocardiographic and hemodynamic response to his-bundle pacing in patients with first-degree atrioventricular block.

Journal Article (Journal Article)

BACKGROUND: Atrial pacing and right ventricular (RV) pacing are both associated with adverse outcomes among patients with first-degree atrioventricular block (1°AVB). His-bundle pacing (HBP) provides physiological activation of the ventricle and may be able to improve both atrioventricular (AV) and inter-ventricular synchrony in 1°AVB patients. This study evaluates the acute echocardiographic and hemodynamic effects of atrial, atrial-His-bundle sequential (AH), and atrial-ventricular (AV) sequential pacing in 1°AVB patients. METHODS: Patients with 1°AVB undergoing atrial fibrillation ablation were included. Following left atrial (LA) catheterization, patients underwent atrial, AH- and AV-sequential pacing. LA/left ventricular (LV) pressure and echocardiographic measurements during the pacing protocols were compared. RESULTS: Thirteen patients with 1°AVB (mean PR 221 ± 26 ms) were included. The PR interval was prolonged with atrial pacing compared to baseline (275 ± 73 ms, p = .005). LV ejection fraction (LVEF) was highest during atrial pacing (62 ± 11%), intermediate with AH-sequential pacing (59 ± 7%), and lowest with AV-sequential pacing (57 ± 12%) though these differences were not statistically significant. No significant differences were found in LA or LV mean pressures or LV dP/dT. LA and LV volumes, isovolumetric times, electromechanical delays, and global longitudinal strains were similar across pacing protocols. CONCLUSION: Despite pronounced PR prolongation, the acute effects of atrial pacing were not significantly different than AH- or AV-sequential pacing. Normalizing atrioventricular and/or inter-ventricular dyssynchrony did not result in acute improvements in cardiac output or loading conditions.

Full Text

Duke Authors

Cited Authors

  • Loring, Z; Holmqvist, F; Sze, E; Alenezi, F; Campbell, K; Koontz, JI; Velazquez, EJ; Atwater, BD; Bahnson, TD; Daubert, JP

Published Date

  • July 2022

Published In

Volume / Issue

  • 27 / 4

Start / End Page

  • e12954 -

PubMed ID

  • 35445488

Pubmed Central ID

  • PMC9296787

Electronic International Standard Serial Number (EISSN)

  • 1542-474X

Digital Object Identifier (DOI)

  • 10.1111/anec.12954


  • eng

Conference Location

  • United States