Impact of His bundle pacing on right ventricular performance in patients undergoing permanent pacemaker implantation
Abstract
BACKGROUND: His-Bundle pacing (HBP) is an emerging technique for physiological pacing. However, its effects on right ventricle (RV) performance are still unknown.
METHODS: We enrolled consecutive patients with an indication for pacemaker (PM) implantation to compare HBP versus RV pacing (RVP) effects on RV performance. Patients were evaluated before implantation and after six months by a transthoracic echocardiogram.
RESULTS: A total of 84 patients (age 75.1+-7.9 years, 64% male) were enrolled, 42 patients (50%) underwent successful HBP, and 42 patients (50%) apical RVP. At follow up, we found a significant improvement in RV-FAC(Fractional Area Change)% [baseline: HBP 34 IQR(31-37) vs.
RVP 33 IQR(29.7-37.2),p = 0.602; 6-months: HBP 37 IQR(33-39) vs. RVP 30 IQR(27.7-35),p<0.0001] and RV-GLS(Global Longitudinal Strain)% [baseline: HBP -18 IQR(-20.2 to -15) vs.
RVP -16 IQR(-18.7 to -14),p = 0.150; 6-months: HBP -20 IQR(-23 to -17) vs. RVP -13.5 IQR(-16 to -11),p<0.0001]with HBP whereas RVP was associated with a significant decline in both parameters.
RVP was also associated with a significant worsening of TAPSE (Tricuspid Annular Plane Systolic Excursion) (p<0.0001) and S wave velocity (p <0.0001) at follow up. Conversely from RVP, HBP significantly improved PASP (Pulmonary Artery Systolic Pressure) [baseline: HBP 38 IQR(32-42)mmHg vs.
RVP 34 IQR(31.5-37)mmHg,p = 0.060; 6-months: HBP 32 IQR(26-38)mmHg vs. RVP 39 IQR(36-41)mmHg, p <0.0001] and tricuspid regurgitation (p = 0.005) irrespectively from lead position above or below the tricuspid valve.
CONCLUSIONS: In patients undergoing PM implantation, HBP ensues a beneficial and protective impact on RV performance compared with RVP.