The success rate of His-Purkinje system pacing in patients with various sites of atrioventricular block / 中华心血管病杂志

Objective: To evaluate the success rate of His-Purkinje system pacing (HPSP) in patients with various sites of atrioventricular block (AVB) and provide clinical evidence for the selection of HPSP in patients with AVB. Methods: This is a retrospective case analysis. 637 patients with AVB who underwent permanent cardiac pacemaker implantation and requiring high proportion of ventricular pacing from March 2016 to September 2021 in the Department of Cardiology, General Hospital of Northern Theater Command were enrolled. The site of AVB was determined by electrophysiological examination. His bundle pacing (HBP) was performed in the first 130 patients (20.4%) who were classified as the HBP group and HPSP included HBP and/or left bundle branch pacing (LBBP) was performed in later 507 patients (79.6%) and these patients were classified as the HPSP group. The basic clinical information such as age and sex of the two groups was compared, and the success rates of HBP or HPSP in patients with different sites of AVB and QRS intervals were analyzed. Results: The age of HBP group was (66.4±15.9) years with 75 males (57.7%). The age of HPSP group was (66.8±13.6) years with 288 (56.8%) males. Among 637 patients, 63.0% (401/637) had atrioventricular node block; 22.9% (146/637) had intra-His block; 14.1% (90/637) had distal or inferior His bundle block. Totally, the success rate of HPSP was higher than that of HBP [93.9% (476/507) vs. 86.9% (113/130), P<0.05]. In each group of patients with various AVB sites, the success rate of HPSP was higher than that of HBP respectively and both success rates of HBP and HPSP showed a declining trend with the distant AVB site. The success rate of HBP in patients with atrioventricular node block and intra-His block was higher than that in patients with distal or inferior His bundle block [95.2% (79/83) vs. 47.1% (8/17), P<0.001; 86.7% (26/30) vs. 47.1% (8/17), P=0.010]. The success rate of HPSP was higher than that of HBP in patients with distal or inferior His bundle block [87.7% (64/73) vs 47.1% (8/17), P=0.001]. In patients with QRS<120 ms, 94.9% (520/548) of AVB sites were in atrioventricular node or intra-His, and HBP had a similar high success rate with HPSP [95.6% (109/114) vs. 96.3% (418/434), P=0.943] in these patients. In patients with QRS ≥ 120 ms, 69.7% (62/89) of AVB sites were at distal or inferior His bundle, and the success rate of HBP was only 25.0% (4/16), while the success rate of HPSP was as high as 79.5% (58/73), P<0.001. Conclusions: In patients with QRS<120 ms and atrioventricular node block or intra-His block, success rates of HBP and HPSP are similarly high and HBP might be considered as the first choice. In patients with QRS ≥ 120 ms and AVB site at distal or inferior His bundle, the success rate of HPSP is higher than that of HBP, suggesting LBBP should be considered as the first-line treatment option.

Sítios endocárdicos alternativos na estimulação cardíaca artificial / Alternative endocardial sites for artificial cardiac stimulation / Sitios endocárdicos alternativos en la estimulación cardíaca artificial

A estimulação ventricular direita convencional pode estar associada a efeitos deletérios sobre a função cardíaca. A necessidade de uma estimulação cardíaca artificial mais fisiológica é, indiscutivelmente, um dos pontos mais importantes na área da eletroterapia cardíaca. Os algoritmos de programação para a manutenção da condução atrioventricular própria, a estimulação de sítios endocárdicos alternativos e a terapia de ressincronização cardíaca são utilizados com o intuito de alcançar este objetivo. A estimulação do feixe de His e a estimulação septal têm sido estudadas como sítios endocárdicos alternativos para o posicionamento do eletrodo no ventrículo direito. A estimulação septal representa uma alternativa simples, prática e sem custos adicionais e com potenciais benefícios na redução dos efeitos deletérios da estimulação do ventrículo direito. Entretanto, esse sítio alternativo envolve um grupo heterogêneo de pacientes e apresenta resultados conflitantes quanto ao seu benefício clínico a longo prazo. Este artigo faz uma revisão das evidências científicas sobre os sítios alternativos de estimulação ventricular direita, com ênfase na segurança do procedimento, na medida dos parâmetros eletrofisiológicos, na avaliação da função ventricular esquerda e no acompanhamento clínico dos pacientes.

The conventional right ventricular stimulation can be associated with deleterious effects on cardiac function. The need for a more physiological artificial cardiac stimulation is undoubtedly one of the most important points in the area of cardiac electrotherapy. The programming algorithms for the maintenance of adequate atrioventricular conduction, the stimulation of alternative endocardial sites and the cardiac resynchronization therapy are used with the objective of attaining these goals. The stimulation of the bundle of His and the septal stimulation have been studied as alternative endocardial sites for the positioning of the electrode on the right ventricle. The septal stimulation represents a simple and practical alternative, with no additional costs involved and with potential benefits in decreasing the deleterious effects of the right ventricular stimulation. However, this alternative site involves a heterogeneous group of patients and presents conflicting results regarding its long-term clinical benefit. This article reviews the scientific evidence on the alternative sites for right ventricular stimulation, with emphasis on the safety of the procedure, the measurement of the electrophysiological parameters, assessment of the left ventricular function and the clinical follow-up of patients.

La estimulación ventricular derecha convencional puede estar asociada a efectos deletéreos sobre la función cardíaca. La necesidad de una estimulación cardíaca artificial más fisiológica es, indiscutiblemente, uno de los puntos más importantes en el área de la electroterapia cardíaca. Los algoritmos de programación para la manutención de la conducción atrioventricular propia, la estimulación de sitios endocárdicos alternativos y la terapia de resincronización cardíaca son utilizados con el propósito de alcanzar este objetivo. La estimulación del haz de His y la estimulación septal han sido estudiadas como sitios endocárdicos alternativos para el posicionamiento del electrodo en el ventrículo derecho. La estimulación septal representa una alternativa simple, práctica y sin costos adicionales y con potenciales beneficios en la reducción de los efectos deletéreos de la estimulación del ventrículo derecho. Entre tanto, ese sitio alternativo envuelve un grupo heterogéneo de pacientes y presenta resultados conflictivos en cuanto a su beneficio clínico a largo plazo. Este artículo hace una revisión de las evidencias científicas sobre los sitios alternativos de estimulación ventricular derecha, con énfasis en la seguridad del procedimiento, en la medida de los parámetros electrofisiológicos, en la evaluación de la función ventricular izquierda y en el control clínico de los pacientes.

Eletrograma não invasivo do sistema de His-purkinje: estudo clínico / Non-invasive electrogram of the His-Purkinje system: a clinical study

Foram estudados 10 pacientes, com idades variando de 20 a 44 anos, analisando-se 100 a 200 ciclos cardíacos consecutivos e, através da técnica de promediaçäo de sinais ("averaging"), procurou-se avaliar o intervalo de 200 a 500 ms que precede a onda R. Com essa técnica conseguiu-se demonstrar, em todos os pacientes examinados, a presença de um potencial correspondente provavelmente à despolarizaçäo do feixe de His