[Permanent His-bundle pacing in patients with infra-Hisian atrioventricular block]. 2006

Rafael Barba-Pichardo, and Pablo Moriña-Vázquez, and José Venegas-Gamero, and Fernando Maroto-Monserrat, and Manuela Cid-Cumplido, and Manuel Herrera-Carranza
Unidad de Arritmias y Marcapasos, Servicio de Cuidados Críticos y Urgencias, Hospital Juan Ramón Jiménez, A. Sundheim 30, 21003 Huelva, Spain. rbphuelva@yahoo.es

OBJECTIVE Permanent His-bundle pacing is effective in patients with supra-Hisian atrioventricular block. We report our experience in patients with infra-Hisian atrioventricular block. METHODS The study involved selected patients referred for syncope and intraventricular conduction disturbance, infra-Hisian atrioventricular block, with left ventricular dyssynchrony and no coronary sinus access. All patients underwent electrophysiological study to evaluate infra-Hisian atrioventricular conduction, both at baseline and after flecainide administration. We selected patients with an indication for permanent pacing in whom His-bundle pacing produced a narrow QRS complex. Leads were implanted in the right atrium, in the bundle of His, and at the apex of the right ventricle, and connected to the atrial, left ventricular, and right ventricular terminals, respectively, of a biventricular pacemaker generator. All pacemakers were programmed in DDD mode with a left ventricle-right ventricle interval of 80 ms. RESULTS Between February and December 2004, seven patients met the study's inclusion criteria. The His-bundle lead was implanted successfully in five. The His-bundle pacing threshold remained stable in two patients, whereas it increased in three. During follow-up, at between 2 and 12 months, no lead dislodgement or failure to capture was observed. Echocardiography did not disclose any deterioration in ventricular function, or any worsening of or new valvular incompetence, but showed that ventricular dyssynchrony had disappeared in previously affected patients. CONCLUSIONS His-bundle pacing is the only pacing mode capable of inducing a physiologically normal ventricular contraction. It can be used in some patients with infra-Hisian atrioventricular block.

UI MeSH Term Description Entries
D002036 Bundle of His Small band of specialized CARDIAC MUSCLE fibers that originates in the ATRIOVENTRICULAR NODE and extends into the membranous part of the interventricular septum. The bundle of His, consisting of the left and the right bundle branches, conducts the electrical impulses to the HEART VENTRICLES in generation of MYOCARDIAL CONTRACTION. Atrioventricular Bundle,Anterior Fascicle,Kent-His Bundle,Left Bundle Branch of His,Posterior Fascicle,Right Bundle Branch of His,Atrioventricular Bundles,Bundle, Atrioventricular,Bundle, Kent-His,Bundles, Atrioventricular,Fascicle, Anterior,Fascicle, Posterior,His Bundle,Kent His Bundle
D002037 Bundle-Branch Block A form of heart block in which the electrical stimulation of HEART VENTRICLES is interrupted at either one of the branches of BUNDLE OF HIS thus preventing the simultaneous depolarization of the two ventricles. Fascicular Block,Anterior Fascicular Block,Bundle Branch Block,Left Bundle-Branch Block,Posterior Fascicular Block,Right Bundle-Branch Block,Anterior Fascicular Blocks,Block, Anterior Fascicular,Block, Bundle Branch,Block, Bundle-Branch,Block, Fascicular,Block, Left Bundle-Branch,Block, Posterior Fascicular,Block, Right Bundle-Branch,Blocks, Anterior Fascicular,Blocks, Bundle Branch,Blocks, Bundle-Branch,Blocks, Fascicular,Blocks, Left Bundle-Branch,Blocks, Posterior Fascicular,Blocks, Right Bundle-Branch,Branch Block, Bundle,Branch Blocks, Bundle,Bundle Branch Blocks,Bundle-Branch Block, Left,Bundle-Branch Block, Right,Bundle-Branch Blocks,Bundle-Branch Blocks, Left,Bundle-Branch Blocks, Right,Fascicular Block, Anterior,Fascicular Block, Posterior,Fascicular Blocks,Fascicular Blocks, Anterior,Fascicular Blocks, Posterior,Left Bundle Branch Block,Left Bundle-Branch Blocks,Posterior Fascicular Blocks,Right Bundle Branch Block,Right Bundle-Branch Blocks
D002304 Cardiac Pacing, Artificial Regulation of the rate of contraction of the heart muscles by an artificial pacemaker. Pacing, Cardiac, Artificial,Artificial Cardiac Pacing,Artificial Cardiac Pacings,Cardiac Pacings, Artificial,Pacing, Artificial Cardiac,Pacings, Artificial Cardiac
D004452 Echocardiography Ultrasonic recording of the size, motion, and composition of the heart and surrounding tissues. The standard approach is transthoracic. Echocardiography, Contrast,Echocardiography, Cross-Sectional,Echocardiography, M-Mode,Echocardiography, Transthoracic,Echocardiography, Two-Dimensional,Transthoracic Echocardiography,2-D Echocardiography,2D Echocardiography,Contrast Echocardiography,Cross-Sectional Echocardiography,Echocardiography, 2-D,Echocardiography, 2D,M-Mode Echocardiography,Two-Dimensional Echocardiography,2 D Echocardiography,Cross Sectional Echocardiography,Echocardiography, 2 D,Echocardiography, Cross Sectional,Echocardiography, M Mode,Echocardiography, Two Dimensional,M Mode Echocardiography,Two Dimensional Echocardiography
D004562 Electrocardiography Recording of the moment-to-moment electromotive forces of the HEART as projected onto various sites on the body's surface, delineated as a scalar function of time. The recording is monitored by a tracing on slow moving chart paper or by observing it on a cardioscope, which is a CATHODE RAY TUBE DISPLAY. 12-Lead ECG,12-Lead EKG,12-Lead Electrocardiography,Cardiography,ECG,EKG,Electrocardiogram,Electrocardiograph,12 Lead ECG,12 Lead EKG,12 Lead Electrocardiography,12-Lead ECGs,12-Lead EKGs,12-Lead Electrocardiographies,Cardiographies,ECG, 12-Lead,EKG, 12-Lead,Electrocardiograms,Electrocardiographies, 12-Lead,Electrocardiographs,Electrocardiography, 12-Lead
D004594 Electrophysiology The study of the generation and behavior of electrical charges in living organisms particularly the nervous system and the effects of electricity on living organisms.
D005500 Follow-Up Studies Studies in which individuals or populations are followed to assess the outcome of exposures, procedures, or effects of a characteristic, e.g., occurrence of disease. Followup Studies,Follow Up Studies,Follow-Up Study,Followup Study,Studies, Follow-Up,Studies, Followup,Study, Follow-Up,Study, Followup
D006327 Heart Block Impaired conduction of cardiac impulse that can occur anywhere along the conduction pathway, such as between the SINOATRIAL NODE and the right atrium (SA block) or between atria and ventricles (AV block). Heart blocks can be classified by the duration, frequency, or completeness of conduction block. Reversibility depends on the degree of structural or functional defects. Auriculo-Ventricular Dissociation,A-V Dissociation,Atrioventricular Dissociation,A V Dissociation,A-V Dissociations,Atrioventricular Dissociations,Auriculo Ventricular Dissociation,Auriculo-Ventricular Dissociations,Block, Heart,Blocks, Heart,Dissociation, A-V,Dissociation, Atrioventricular,Dissociation, Auriculo-Ventricular,Dissociations, A-V,Dissociations, Atrioventricular,Dissociations, Auriculo-Ventricular,Heart Blocks
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D013997 Time Factors Elements of limited time intervals, contributing to particular results or situations. Time Series,Factor, Time,Time Factor

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