Left ventricular activation time and pattern are preserved with both selective and nonselective His bundle pacing
Ahran Arnold, Matthew Shun‐Shin, Nadine Ali, Daniel Keene, James P. Howard, Ji‐Jian Chow, Norman Qureshi, Michael Koa‐Wing, Mark Tanner, David Lefroy, Nick Linton, Fu Siong Ng, Phang Boon Lim, Nicholas S. Peters, Prapa Kanagaratnam, Dárrel P. Francis, Zachary I. Whinnett
Abstract
BACKGROUND: His bundle pacing (HBP) can be achieved in 2 ways: selective HBP (S-HBP), where the His bundle is captured alone, and nonselective HBP (NS-HBP), where local myocardium is also captured, resulting a pre-excited electrocardiogram appearance. OBJECTIVE: We assessed the impact of this ventricular pre-excitation on left and right ventricular dyssynchrony. METHODS: We recruited patients who displayed both S-HBP and NS-HBP. We performed noninvasive epicardial electrical mapping for left and right ventricular activation time (LVAT and RVAT) and pattern. RESULTS: = .108) compared to S-HBP. Activation pattern of the left ventricular surface was unchanged between S-HBP and NS-HBP, but NS-HBP produced early basal right ventricular activation that was not seen in S-HBP. CONCLUSION: Compared to S-HBP, local myocardial capture during NS-HBP produces pre-excitation of the basal right ventricle resulting in QRS duration prolongation. However, NS-HBP preserves the left ventricular activation time and pattern of S-HBP. Left ventricular dyssynchrony is not an important factor when choosing between S-HBP and NS-HBP in most patients.