title: Usefulness of His Bundle Pacing to Achieve Electrical Resynchronization in Patients With Complete Left Bundle Branch Block and the Relation Between Native QRS Axis, Duration, and Normalization.
abstract: His Bundle pacing (HBP) restores electrical synchronization in left bundle branch block (LBBB); however, the underlying mechanisms are poorly understood. We examined the relation between native QRS axis in LBBB, a potential indicator of the site of block, and QRS normalization in patients with LBBB. Data from patients (n = 41) undergoing HBP at 3 sites were studied (68 ± 13 years, 13 women). Study criteria included strictly defined complete LBBB and successful implantation of a permanent HBP lead. Preprocedure and postprocedure electrocardiograms were reviewed independently by 2 blinded readers. QRS axis and duration were measured to the nearest 10° and 10 ms, respectively. QRS narrowing or normalization was the primary end point. Of 29 patients meeting study criteria, 9 had frontal plane QRS axes between -60° and -80°, 10 from -40° to 0°, and 10 from +1° to +90°. QRS narrowing occurred in 24 patients (83%, 44 ± 34 ms, p <0.05). Percent QRS narrowing by axis were 26 ± 19%, 29 ± 25%, and 28 ± 23%, respectively. No correlation between prepacing QRS axis and postpacing narrowing was identified (r(2) = 0.001, p = 0.9). In patients with or without QRS normalization after HBP, mean QRS duration was 155 ± 21 vs 171 ± 8 ms, respectively, p = 0.014. HBP induces significant QRS narrowing in most patients and normalization in patients with shorter baseline QRS duration. In conclusion, the lack of correlation between native QRS axis and narrowing suggests that proximal His-Purkinje block causes most cases of LBBB, or that additional mechanisms underlie HBP efficacy. Further studies are needed to better understand how to predict those patients in whom HBP will normalize LBBB.
authors.affiliation: University of California Los Angeles Cardiac Arrhythmia Center, Los Angeles, California.
authors.forename: Alexandra E
authors.initials: AE
authors.lastname: Teng
authors.affiliation: University of Vermont Medical Center, Burlington, Vermont.
authors.forename: Daniel L
authors.initials: DL
authors.lastname: Lustgarten
authors.affiliation: Geisinger Medical Center, Wilkes-Barre, Pennsylvania.
authors.forename: Pugazhendhi
authors.initials: P
authors.lastname: Vijayaraman
authors.affiliation: University of Chicago Heart Rhythm Center, Chicago, Illinois.
authors.forename: Roderick
authors.initials: R
authors.lastname: Tung
authors.affiliation: University of California Los Angeles Cardiac Arrhythmia Center, Los Angeles, California.
authors.forename: Kalyanam
authors.initials: K
authors.lastname: Shivkumar
authors.affiliation: Duke University School of Medicine, Durham, North Carolina.
authors.forename: Galen S
authors.initials: GS
authors.lastname: Wagner
authors.affiliation: University of California Los Angeles Cardiac Arrhythmia Center, Los Angeles, California. Electronic address: oajijola@mednet.ucla.edu.
authors.forename: Olujimi A
authors.initials: OA
authors.lastname: Ajijola
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002036:Bundle of His; D002037:Bundle-Branch Block / Q000503:physiopathology / Q000628:therapy*; D058406:Cardiac Resynchronization Therapy / Q000379:methods*; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome