His bundle pacing: a new strategy for physiological ventricular activation
File(s)
Author(s)
Lewis, Andrew JM
Foley, Paul
Whinnett, Zachary
Keene, Daniel
Chandrasekaran, Badrinathan
Type
Journal Article
Abstract
The specialized fibers of the His‐Purkinje system are essential for the maintenance of the coordinated, synchronous ventricular contraction via endocardial to epicardial and apical to basal electrical activation. The right ventricle has been the most commonly used site to deliver artificial pacemaker stimuli since the 1950s, although pacing from both right ventricular (RV) apical and septal positions causes ventricular dyssynchrony, which is in turn associated with deleterious consequences including impaired myocardial perfusion,1 mitral and tricuspid regurgitation,2 an increased risk of atrial fibrillation, and systolic contractile dysfunction.3 As a result, the risk of hospitalization for heart failure was strikingly increased in patients receiving a higher proportion of ventricular pacing in the DAVID (Dual Chamber and VVI Implantable Defibrillator) trial 4, 5 and MOST (Mode Selection Trial)6 alongside an increased risk of ventricular tachycardia/fibrillation.7 Current guidelines8 and pacemaker algorithms9 therefore promote the minimization of right ventricular pacing wherever possible; however, excessive restriction of RV pacing with, for example, long atrioventricular delays impairs atrioventricular synchrony, increasing the risk of atrioventricular block at higher atrial rates and predisposing to mitral regurgitation. Furthermore, current strategies for the reduction of RV pacing have not improved clinical outcomes.10
Date Issued
2019-03-19
Date Acceptance
2019-03-01
Citation
Journal of the American Heart Association : Cardiovascular and Cerebrovascular Disease, 2019, 8 (6), pp.e010972-e010972
ISSN
2047-9980
Publisher
Wiley
Start Page
e010972
End Page
e010972
Journal / Book Title
Journal of the American Heart Association : Cardiovascular and Cerebrovascular Disease
Volume
8
Issue
6
Copyright Statement
© 2019 The Authors. Published on behalf of the American Heart Association,Inc., by Wiley. This is an open access article under the terms of the CreativeCommons Attribution-NonCommercial License, which permits use, distribu-tion and reproduction in any medium, provided the original work is properlycited and is not used for commercial purposes.
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/30854911
Subjects
His bundle
pacemaker
resynchronization
Publication Status
Published
Coverage Spatial
England
Date Publish Online
2019-03-09