First Department of Cardiology, Interventional Electrocardiology, and Hypertension, Jagiellonian University Medical College, Kraków, Poland.
Cardiocenter, Department of Cardiology, 3rd Medical Faculty of Charles University in Prague, Prague, Czech Republic.
J Cardiovasc Electrophysiol. 2021 Jan;32(1):117-125. doi: 10.1111/jce.14834. Epub 2020 Dec 18.
We aimed to compare the acute differences in left ventricular (LV) function and mechanical synchrony during nonselective His bundle pacing (ns-HBP) versus selective His bundle pacing (s-HBP) using strain echocardiography.
Consecutive patients with permanent His bundle pacing, in whom it was possible to obtain both s-HBP and ns-HBP, were studied in two centers. In each patient, echocardiography was performed sequentially during s-HBP and ns-HBP. Speckle-tracking echocardiography parameters were analyzed: Global longitudinal strain (GLS), the time delay between peak systolic strain in the basal septal and basal lateral segments (BS-BL delay), peak strain dispersion (PSD) and strain delay index. Right ventricle function was assessed using tricuspid annular plane systolic excursion (TAPSE) and tissue Doppler velocity of the lateral tricuspid annulus (S'). A total of 69 patients (age: 75.6 ± 10.5 years; males: 75%) were enrolled. There were no differences in LV ejection fraction and GLS between s-HBP and ns-HBP modes: 59% versus 60%, and -15.6% versus -15.7%, respectively; as well as no difference in BS-BL delay and strain delay index. The PSD value was higher in the ns-HBP group than in the s-HBP group with the most pronounced difference in the basal LV segments. No differences in right ventricular function parameters (TAPSE and S') were found.
The ns-HBP and s-HBP modes seem comparable regarding ventricular function. The dyssynchrony parameters were significantly higher during ns-HBP, however, the difference seems modest and clarification of its impact on LV function requires a larger long-term study.
我们旨在使用应变超声心动图比较非选择性希氏束起搏（ns-HBP）与选择性希氏束起搏（s-HBP）时左心室（LV）功能和机械同步性的急性差异。
在两个中心研究了连续接受永久性希氏束起搏的患者，这些患者可以同时获得 s-HBP 和 ns-HBP。在每个患者中，在 s-HBP 和 ns-HBP 期间连续进行超声心动图检查。分析斑点追踪超声心动图参数：整体纵向应变（GLS）、基底间隔和基底外侧节段收缩期峰值应变之间的时间延迟（BS-BL 延迟）、应变离散度（PSD）和应变延迟指数。使用三尖瓣环平面收缩期位移（TAPSE）和外侧三尖瓣环组织多普勒速度（S'）评估右心室功能。共纳入 69 例患者（年龄：75.6±10.5 岁；男性：75%）。s-HBP 和 ns-HBP 模式之间的 LV 射血分数和 GLS 无差异：分别为 59%和 60%，-15.6%和-15.7%；BS-BL 延迟和应变延迟指数也无差异。PSD 值在 ns-HBP 组中高于 s-HBP 组，在基底 LV 节段差异最明显。右心室功能参数（TAPSE 和 S'）无差异。
ns-HBP 和 s-HBP 模式在心室功能方面似乎相似。ns-HBP 时，不同步参数明显更高，但差异似乎较小，其对 LV 功能的影响需要更大的长期研究来阐明。
