Vijayaraman Pugazhendhi, Dandamudi Gopi, Lustgarten Daniel, Ellenbogen Kenneth A
Geisinger Wyoming Valley Medical Center, Wilkes-Barre, PA.
Indiana University, Indianapolis, IN.
Pacing Clin Electrophysiol. 2017 Jul;40(7):883-891. doi: 10.1111/pace.13130. Epub 2017 Jun 30.
Permanent His bundle pacing (HBP) is a physiological alternative to right ventricular pacing. It is not known whether HBP can cause His-Purkinje conduction (HPC) disease. The aim of our study is to assess His bundle capture and its effect on left ventricular (LV) function in long-term follow-up and to determine HPC at the time of pulse generator change (GC) in patients with chronic HBP.
HB electrograms were recorded from the pacing lead at implant and GC. HBP QRS duration (QRSd), His-ventricular (HV) intervals, and HB pacing thresholds at GC were compared with implant measurements. HPC was assessed by pacing at cycle lengths of 700 ms, 600 ms, and 500 ms at GC. LV internal diameters, ejection fraction (EF), and valve dysfunction at baseline were compared with echocardiography during follow-up.
GC was performed in 20 patients (men 13; age 74 ± 14 years) with HBP at 70 ± 24 months postimplant. HV intervals remained unchanged from initial implant (44 ± 4 ms vs 45 ± 4 ms). During HBP at 700 ms, 600 ms, and 500 ms (n = 17), consistent 1:1 HPC was present. HBP QRSd remained unchanged during follow-up (117 ± 20 ms vs 118 ± 23 ms). HBP threshold at implant and GC was 1.9 ± 1.1 V and 2.5 ± 1.2 V @ 0.5 ms. Despite high pacing burden (77 ± 13%), there was no significant change in LVEF (50 ± 14% at implant) during follow-up (55 ± 6%, P = 0.06).
HBP does not appear to cause new HPC abnormalities and is associated with stable HBP QRSd during long-term follow-up. Despite high pacing burden, HBP did not result in deterioration of left ventricular systolic function or cause new valve dysfunction.
永久性希氏束起搏（HBP）是右心室起搏的一种生理性替代方法。目前尚不清楚HBP是否会导致希氏-浦肯野传导（HPC）疾病。我们研究的目的是在长期随访中评估希氏束夺获及其对左心室（LV）功能的影响，并确定慢性HBP患者在脉冲发生器更换（GC）时的HPC情况。
在植入时和GC时从起搏导线记录希氏束电图。将GC时的HBP QRS时限（QRSd）、希氏束-心室（HV）间期和HBP起搏阈值与植入时的测量值进行比较。在GC时通过以700 ms、600 ms和500 ms的周期长度起搏来评估HPC。将基线时的左心室内径、射血分数（EF）和瓣膜功能障碍与随访期间的超声心动图结果进行比较。
20例患者（男性13例；年龄74±14岁）在植入后70±24个月进行了GC，这些患者均接受HBP治疗。HV间期与初始植入时相比无变化（44±4 ms对45±4 ms）。在以700 ms、600 ms和500 ms进行HBP期间（n = 17），存在一致的1:1 HPC。随访期间HBP QRSd无变化（117±20 ms对118±23 ms）。植入时和GC时的HBP阈值分别为1.9±1.1 V和2.5±1.2 V @ 0.5 ms。尽管起搏负担较高（77±13%），但随访期间左心室射血分数（植入时为50±14%）无显著变化（55±6%，P = 0.06）。
HBP似乎不会导致新的HPC异常，并且在长期随访中与稳定的HBP QRSd相关。尽管起搏负担较高，但HBP并未导致左心室收缩功能恶化或引起新的瓣膜功能障碍。
