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| Acute Change of LV dyssynchrony and Cardiac Output Between RV apical pacing and His bundle pacing in Koreans with Normal cardiac function |
| 가톨릭 대학교 대전성모병원 |
| 김형두, 허성호, 윤희정, 진승원, 백주열, 조정선, 장성원, 신우승, 승기배, 노태호 |
Background and objectives : Many evidence from several pacemaker or ICD trials has emerged on the acute and long term detrimental effects of RV apical pacing on LV function. Unphysiologic LV depolarization, and in tern mechanical LV dyssynchrony due to RV apical pacing, may underlie these harmful effect. In contrast RV apical pacing, His bundle pacing dose not induces ventricular dyssynchrony However, few data are currently available on the feasibility of His bundle pacing and its acute electomechamical effects in comparison with those of RV apical pacing. The purpose of this prospective study was to evaluate the acute changes of cardiac synchrony and function according to Pacing sites (RV apex, and His bundle) in Korean normal subjects with normal systolic function and narrow QRS.
Method : We conducted this study with twenty patient (10 men, 49.5±7.6 years) with
normal cardiac function and normal ECG. Intracardiac pacing was performed in RV apex
and His bundle in a sequential manner. Transthoracic echocardiogram was conducted at
rest and during pacing in order to measure to ventricular dyssynchrony and cardiac
output.
Result :
The results were as follows.
1. QRS duration (93.6±24.6 msec) of His pacing was significantly shorter than that of RVA pacing (142.1±9.6 msec, P<0.001) but no significant difference with baseline
2. We noted statistically significant difference in cardiac output according to the pacing sites (RVA; 4.78±1.76 L/min, His; 6.81±2.46 L/min ; P =0.044).
3. Inter-ventricular dyssynchrony with M-mode and Doppler echocardiography in RVA pacing was insignificantly increased as compared to those with His pacing
4. The intra-ventricular dyssynchrony with tissue Doppler echocardiography in His pacing was reduced significantly as compared with that of RVA pacing (His ; 32.73±38.04 msec, RVA ; 69.80±33.59 msec ; P =0.008)
Conclusion : Acute His bundle pacing dose not induce LV dyssynchrony and improve cardiac output compare with conventional RV apical pacing
KEY WORDS : LV dyssynchrony, His bundle pacing
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Table . Comparison of the acute change of echocardiographic cardiac synchrony and cardiac output on each pacing site (RV apex, His bundle) with baseline parameters
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Baseline |
RVA pacing |
His pacing |
P valuea |
P vlaueb |
P valuec |
QRS width (msec) |
81.75±18.39 |
142.08±9.60 |
93.67±24.68 |
<0.001 |
0.180 |
<0.001 |
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Cardiacoutput (L/min) |
4.63±1.25 |
4.78±1.76 |
6.81±2.49 |
0.851 |
0.014 |
0.044 |
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Intraventricular
QSI measure(msec) |
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35.17±30.69 |
69.80±33.59 |
32.73±38.04 |
0.054 |
0.852 |
0.008 |
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Interventricular
M mode(msec)
Doppler(msec) |
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64.58±21.07 |
100.47±32.85 |
83.33±22.87 |
0.014 |
0.096 |
0.138 |
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13.75±11.41 |
29.60±21.46 |
25.60±24.31 |
0.050 |
0.309 |
0.605 |
a : baseline vs RVA pacing b : bascline vs His pacing c : RVA pacing vs His pacing
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