His bundle capture proximal to the site of bundle branch block: A novel pitfall of the para-Hisian pacing maneuver

Paradoxical Para-Hisian Pacing Response

Para-Hisian pacing (PHP) is among the most useful maneuvers in cardiac electrophysiology during sinus rhythm and identifies whether retrograde conduction is dependent on the atrioventricular (AV) node. In this maneuver, the retrograde activation time and pattern are compared during capture and loss of capture of the His bundle while pacing from a para-Hisian position. A common misconception about PHP is that it is useful only for septal accessory pathways (APs). However, even with left or right lateral pathways, as long as pacing from the para-Hisian region conducts to the atrium with the activation sequence being analyzed, it can be used to determine whether that activation is AV node-dependent or AP-dependent.

Effects of His bundle pacing and right ventricular apex pacing on cardiac electrical and mechanical synchrony and cardiac function in patients with heart failure and atrial fibrillation

OBJECTIVE

To investigate the effects of right ventricular apex pacing and His bundle pacing on cardiac mechanical and electrical synchrony and cardiac function in patients with heart failure and atrial fibrillation.

METHODS

A total of 72 patients with heart failure and atrial fibrillation who received permanent pacemaker implantation in our hospital were randomly divided into two groups, with 36 patients in each group. The control group received the right ventricular apex pacing, and the study group received His bundle pacing. In the two groups, the pacing parameters, cardiac function, cardiac electricity, mechanical synchrony, complications and living quality were compared.

RESULTS

During operation and 12 months after the operation, the study group's pacing threshold was higher than the pacing threshold of the control group (all P<0.001). Compared with that before the procedure, NYHA grade and LVEDD of the two groups 12 months after operation were decreased (all P<0.001), while LVEF and various quality of life scores were increased (all P<0.001). The study group's NYHA grade and LVEDD were lower than those of the control group 12 months after operation (all P<0.001), while the study group's quality of life scores and LVEF were higher than those of the control group (all P<0.001). Twelve months after operation, the study group's QRS width and IVMD were lower than QRS width and IVMD of the control group (all P<0.001). The study group's complication rate was 5.56% (2/36), which was lower than the control group's complication rate (22.22% (8/36), P<0.05).

CONCLUSION

Compared with right ventricular apical pacing, His bundle pacing in the treatment of heart failure with atrial fibrillation can better maintain the cardiac electrical and mechanical synchronization, promote the recovery of cardiac function, improve living quality, and has fewer complications and significant advantages.

A dual nodal response to the parahisian pacing and induction of the retrograde right bundle branch block maneuvers

We presented intracardiac electrograms during the parahisian pacing, which represent three types of retrograde conduction and focus on the mechanism of types of retrograde conduction on wide QRS complexes and conclude that the two types of QRS of the retrograde conduction resulted from the presence or absence of retrograde block at the right bundle branch.