Discussion
We found a significant difference in the activation patterns between
sinus rhythm and HB pacing. During sinus rhythm the earliest site of
myocardial activation was in the LV septum and during HB pacing it was
in the RV. The activation pattern of the LV was different in sinus
rhythm (apex to base) when compared to HB (high septum to apex).
Para-Hisian or non-selective HB pacing leads to simultaneous activation
of the HB and adjacent myocardium.(3) This study suggests that during HB
pacing, local myocardial capture can be present despite a narrow QRS and
an isoelectric interval on surface ECG between pacing and earliest V.
1. Yancy CW, Jessup M, Bozkurt B et al. 2017 ACC/AHA/HFSA Focused Update
of the 2013 ACCF/AHA Guideline for the Management of Heart Failure: A
Report of the American College of Cardiology/American Heart Association
Task Force on Clinical Practice Guidelines and the Heart Failure Society
of America. J Am Coll Cardiol 2017;70:776-803.
2. Sharma PS, Dandamudi G, Herweg B et al. Permanent His-bundle pacing
as an alternative to biventricular pacing for cardiac resynchronization
therapy: A multicenter experience. Heart Rhythm 2018;15:413-420.
3. Cantu F, De Filippo P, Cardano P, De Luca A, Gavazzi A. Validation of
criteria for selective his bundle and para-hisian permanent pacing.
Pacing Clin Electrophysiol 2006;29:1326-33.