Department of Biomedical Engineering, University of Utah, Salt Lake City, Utah.
Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, Utah.
Am J Physiol Heart Circ Physiol. 2021 Jan 1;320(1):H13-H22. doi: 10.1152/ajpheart.00292.2020. Epub 2020 Oct 30.
His bundle pacing utilizes the His-Purkinje system to produce more physiological activation compared with traditional pacing therapies, but differences in electrical activation between pacing techniques are not yet quantified in terms of activation pattern. Furthermore, clinicians distinguish between selective and nonselective His pacing, but measurable differences in electrical activation remain to be seen. Hearts isolated from seven dogs were perfused using the Langendorff method. Electrograms were recorded using two 64-electrode basket catheters in the ventricles and a 128-electrode sock situated around the ventricles during sinus rhythm (right atrial pacing), right ventricular (RV) pacing, biventricular cardiac resynchronization therapy (biV-CRT), selective His pacing (selective capture of the His bundle), and nonselective His pacing (capture of nearby myocardium and His bundle). Activation maps were generated from these electrograms. Total activation time (TAT) was measured from the activation maps, and QRS duration was measured from a one-lead pseudo-ECG. Results showed that TAT, QRS duration, and activation sequence were most similar between sinus, selective, and nonselective His pacing. Bland-Altman analyses showed highest levels of similarity between all combinations of sinus, selective, and nonselective His pacing. RV and biV-CRT activation patterns were distinct from sinus and had significantly longer TAT and QRS duration. Cumulative activation graphs were most similar between sinus, selective, and nonselective His pacing. In conclusion, selective pacing and nonselective His bundle pacing are more similar to sinus compared with RV and biV-CRT pacing. Furthermore, selective pacing and nonselective His bundle pacing are not significantly different electrically. Our high-density epicardial and endocardial electrical mapping study demonstrated that selective pacing and nonselective His bundle pacing are more electrically similar to sinus rhythm compared with right ventricular and biventricular cardiac resynchronization therapy pacing. Furthermore, small differences between selective and nonselective His bundle pacing, specifically a wider QRS in nonselective His pacing, do not translate into significant differences in the global activation pattern.
希氏束起搏利用希氏-浦肯野系统产生更生理性的激活，与传统起搏治疗相比，但起搏技术之间的电激活差异尚未在激活模式方面进行量化。此外，临床医生区分选择性和非选择性希氏束起搏，但电激活方面的可测量差异仍有待观察。将 7 只狗的心脏用 Langendorff 法进行灌注。在窦性节律（右心房起搏）、右心室（RV）起搏、双心室心脏再同步治疗（biV-CRT）、选择性希氏束起搏（选择性捕获希氏束）和非选择性希氏束起搏（捕获附近心肌和希氏束）期间，使用两个 64 电极篮状导管和一个位于心室周围的 128 电极袜子在心室中记录心电图。从这些心电图生成激活图。从激活图中测量总激活时间（TAT），从单导联伪 ECG 测量 QRS 持续时间。结果表明，TAT、QRS 持续时间和激活序列在窦性、选择性和非选择性希氏束起搏之间最为相似。Bland-Altman 分析显示窦性、选择性和非选择性希氏束起搏之间的相似性最高。RV 和 biV-CRT 的激活模式与窦性不同，具有明显更长的 TAT 和 QRS 持续时间。累积激活图在窦性、选择性和非选择性希氏束起搏之间最为相似。总之，与 RV 和 biV-CRT 起搏相比，选择性起搏和非选择性希氏束起搏与窦性起搏更为相似。此外，选择性起搏和非选择性希氏束起搏在电生理上没有显著差异。我们的高密度心外膜和心内膜电描记图研究表明，与右心室和双心室心脏再同步治疗起搏相比，选择性起搏和非选择性希氏束起搏在电生理上更类似于窦性节律。此外，选择性和非选择性希氏束起搏之间的微小差异，特别是非选择性希氏束起搏时 QRS 较宽，不会导致整体激活模式的显著差异。
