Visualization of Left Ventricular Endocardium Activation Time during Cardiac Conduction System Pacing

Keywords: pacemaker, atrioventricular block, His bundle pacing, left bundle branch pacing, navigation system

Abstract

Introduction. Right ventricular myocardial pacing leads to asynchronous contraction of the left ventricle (LV) and can impair its contractility over time. Stimulation of the conduction system of the heart ensures physiological activation of the ventricles.

The aim. To visualize the pattern of propagation of the electrical front on the activation map of the LV endocardium during conduction system pacing and during right ventricular myocardial pacing.

Materials and methods. In two patients with the conduction system pacing, who were operated at the National Amosov Institute of Cardiovascular Surgery, invasive LV activation mapping was performed on various options of cardiac pacing using the EnSite Precision TM navigation system. One patient with complete atrioventricular block had nonselective His bundle pacing. The second patient had dilated cardiomyopathy and indications for cardiac resynchronization therapy and ablation of the atrioventricular junction due to chronic tachyform of atrial fibrillation. After an unsuccessful attempt to place LV lead in coronary sinus, a lead for left bundle branch pacing was implanted. Different activation maps of the LV endocardium were built in two patients with two types of cardiac pacing: right ventricular myocardial pacing and cardiac conduction system pacing.

Results. The total LV endocardial activation time was significantly different in the two studied patients with different pacing options. In a patient with non-selective stimulation of His bundle, the total LV endocardial activation time was 43 ms (QRS width 126 ms, the interval from the stimulus to the peak of the R wave in lead V6 78 ms). After switching to right ventricular myocardial pacing with a decrease in the pacing amplitude, the total LV endocardial activation time prolonged to 90 ms (QRS width 165 ms, the interval from the stimulus to the peak of the R wave in lead V6 117 ms). In a patient with left bundle branch pacing, total LV endocardial activation time was 51 ms (QRS width 160 ms, the interval from the stimulus to the peak of the R wave in lead V6 66 ms). With switching exclusively to right ventricular pacing the total LV endocardial activation time prolonged to 93 ms (stimulated QRS width 180 ms). At the same time, the activation pattern of the LV endocardium was significantly different, since the right ventricular lead was located closer to the apex.

Conclusions. Conduction system pacing provides rapid physiological LV activation and potentially avoids the negative consequences of asynchronous slow ventricular activation during right ventricular pacing.

References

  1. Abdelrahman M, Subzposh FA, Beer D, Durr B, Naperkowski A, Sun H, et al. Clinical Outcomes of His Bundle Pacing Compared to Right Ventricular Pacing. J Am Coll Cardiol. 2018;71(20):2319-2330. https://doi.org/10.1016/j.jacc.2018.02.048
  2. Sharma PS, Patel NR, Ravi V, Zalavadia DV, Dommaraju S, Garg V, et al. Clinical outcomes of left bundle branch area pacing compared to right ventricular pacing: Results from the Geisinger-Rush Conduction System Pacing Registry. Heart Rhythm. 2022;19(1):3-11. https://doi.org/10.1016/j.hrthm.2021.08.033
  3. Vijayaraman P, Chelu MG, Curila K, Dandamudi G, Herweg B, Mori S, et al. Cardiac Conduction System Pacing: A Comprehensive Update. JACC Clin Electrophysiol. 2023;9(11):2358-2387. https://doi.org/10.1016/j.jacep.2023.06.005
  4. Deshmukh P, Casavant DA, Romanyshyn M, Anderson K. Permanent, Direct His-Bundle Pacing: A Novel Approach to Cardiac Pacing in Patients With Normal His-Purkinje Activation. Circulation. 2000;101(8):869-877. https://doi.org/10.1161/01.cir.101.8.869
  5. Huang W, Su L, Wu S, Xu L, Xiao F, Zhou X, et al. A NovelPacing Strategy With Low and Stable Output: Pacing the Left Bundle Branch Immediately Beyond the Conduction Block. Can J Cardiol. 2017;33(12):1736.e1-1736.e3. https://doi.org/10.1016/j.cjca.2017.09.013
  6. Zhuo W, Zhong X, Liu H, Yu J, Chen Q, Hu J, et al. Pacing Characteristics of His Bundle Pacing vs. Left Bundle Branch Pacing: A Systematic Review and Meta-Analysis. Front Cardiovasc Med. 2022 Mar 22;9:849143. https://doi.org/10.3389/fcvm.2022.849143
  7. Prinzen FW, Van Oosterhout MF, Vanagt WY, Storm C, Reneman RS. Optimization of Ventricular Function by Improving the Activation Sequence During Ventricular Pacing. Pacing Clin Electrophysiol. 1998;21(11 Pt 2):2256-2260. https://doi.org/10.1111/j.1540-8159.1998.tb01163.x
  8. Peschar M, de Swart H, Michels KJ, Reneman RS, Prinzen FW. Left ventricular septal and apex pacing for optimal pump function in canine hearts. J Am Coll Cardiol. 2003;41(7):1218-1226. https://doi.org/10.1016/s0735-1097(03)00091-3
  9. Lewis AJM, Foley P, Whinnett Z, Keene D, Chandrasekaran B. His Bundle Pacing: A New Strategy for Physiological Ventricular Activation. J Am Heart Assoc. 2019 Mar 19;8(6):e010972. https://doi.org/10.1161/JAHA.118.010972
  10. Yasin O, Vaidya V, Tri J, Van Zyl M, Ladejobi A, Xiao P, et al. Activation pattern during his pacing: how close are we to normal physiology? Eur Heart J. 2020 Nov;41Suppl 2:ehaa946.0804. https://doi.org/10.1093/ehjci/ehaa946.0804
  11. Hirahara AM, Lange M, Shah A, Khan MS, Ranjan R, Stoddard G, et al. His bundle pacing shows similar ventricular electrical activation as sinus: selective and nonselective His pacing indistinguishable. Am J Physiol Heart Circ Physiol. 2021;320(1):H13-H22. https://doi.org/10.1152/ajpheart.00292.2020
  12. Meiburg R, Rijks JHJ, Beela AS, Bressi E, Grieco D, Delhaas T, et al. Comparison of novel ventricular pacing strategies using an electro-mechanical simulation platform. Europace. 2023 Jun 2;25(6):euad144. https://doi.org/10.1093/europace/euad144
  13. Arnold AD, Shun-Shin MJ, Ali N, Keene D, Howard JP, Chow JJ, et al. Left ventricular activation time and pattern are preserved with both selective and nonselective His bundle pacing. Heart Rhythm O2. 2021;2(5):439-445. https://doi.org/10.1016/j.hroo.2021.08.001
  14. Jastrzębski M, Burri H, Kiełbasa G, Curila K, Moskal P, Bednarek A, et al. The V6-V1 interpeak interval: a novel criterion for the diagnosis of left bundle branch capture. Europace. 2022;24(1):40-47. https://doi.org/10.1093/europace/euab164
  15. Cho SW, Gwag HB, Hwang JK, Chun KJ, Park KM, On YK, et al. Clinical features, predictors, and long-term prognosis of pacing-induced cardiomyopathy. Eur J Heart Fail. 2019;21(5):643-651. https://doi.org/10.1002/ejhf.1427
  16. Kim JH, Kang KW, Chin JY, Kim TS, Park JH, Choi YJ. Major determinant of the occurrence of pacing-induced cardiomyopathy in complete atrioventricular block: a multicentre, retrospective analysis over a 15-year period in South Korea. BMJ Open. 2018 Feb 8;8(2):e019048. https://doi.org/10.1136/bmjopen-2017-019048
  17. Somma V, Ha FJ, Palmer S, Mohamed U, Agarwal S. Pacing-induced cardiomyopathy: A systematic review and meta-analysis of definition, prevalence, risk factors, and management. Heart Rhythm. 2023;20(2):282-290. https://doi.org/10.1016/j.hrthm.2022.09.019
  18. Perepeka YeO, Lazoryshynets VV. [Comparative analysis of long-term outcomes following the stimulation of cardiac conduction system and right ventricular pacing in patients with bradyarrhythmias]. Aktualni problemy suchasnoi medytsyny: Visnyk Ukrainskoi medychnoi stomatolohichnoi akademii. 2023;23(3):31-36. Ukrainian. https://doi.org/10.31718/2077-1096.23.3.31
Published
2023-12-28
How to Cite
Perepeka, E. O. (2023). Visualization of Left Ventricular Endocardium Activation Time during Cardiac Conduction System Pacing. Ukrainian Journal of Cardiovascular Surgery, 31(4), 79-85. https://doi.org/10.30702/ujcvs/23.31(04)/Per058-7985

Most read articles by the same author(s)