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Loring Z, Holmqvist F, Sze E, Alenezi F, Campbell K, Koontz JI, Velazquez EJ, Atwater BD, Bahnson TD, Daubert JP. Acute echocardiographic and hemodynamic response to his-bundle pacing in patients with first-degree atrioventricular block. Ann Noninvasive Electrocardiol 2022; 27:e12954. [PMID: 35445488 PMCID: PMC9296787 DOI: 10.1111/anec.12954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 03/02/2022] [Accepted: 03/14/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Atrial pacing and right ventricular (RV) pacing are both associated with adverse outcomes among patients with first-degree atrioventricular block (1°AVB). His-bundle pacing (HBP) provides physiological activation of the ventricle and may be able to improve both atrioventricular (AV) and inter-ventricular synchrony in 1°AVB patients. This study evaluates the acute echocardiographic and hemodynamic effects of atrial, atrial-His-bundle sequential (AH), and atrial-ventricular (AV) sequential pacing in 1°AVB patients. METHODS Patients with 1°AVB undergoing atrial fibrillation ablation were included. Following left atrial (LA) catheterization, patients underwent atrial, AH- and AV-sequential pacing. LA/left ventricular (LV) pressure and echocardiographic measurements during the pacing protocols were compared. RESULTS Thirteen patients with 1°AVB (mean PR 221 ± 26 ms) were included. The PR interval was prolonged with atrial pacing compared to baseline (275 ± 73 ms, p = .005). LV ejection fraction (LVEF) was highest during atrial pacing (62 ± 11%), intermediate with AH-sequential pacing (59 ± 7%), and lowest with AV-sequential pacing (57 ± 12%) though these differences were not statistically significant. No significant differences were found in LA or LV mean pressures or LV dP/dT. LA and LV volumes, isovolumetric times, electromechanical delays, and global longitudinal strains were similar across pacing protocols. CONCLUSION Despite pronounced PR prolongation, the acute effects of atrial pacing were not significantly different than AH- or AV-sequential pacing. Normalizing atrioventricular and/or inter-ventricular dyssynchrony did not result in acute improvements in cardiac output or loading conditions.
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Affiliation(s)
- Zak Loring
- Division of CardiologyDepartment of MedicineDuke UniversityDurhamNorth CarolinaUSA
- Duke Clinical Research InstituteDurhamNorth CarolinaUSA
| | - Fredrik Holmqvist
- Division of CardiologyDepartment of MedicineDuke UniversityDurhamNorth CarolinaUSA
- Department of CardiologyLund UniversityLundSweden
| | - Edward Sze
- Division of CardiologyDepartment of MedicineDuke UniversityDurhamNorth CarolinaUSA
- Maine Medical CenterPortlandMaineUSA
| | - Fawaz Alenezi
- Division of CardiologyDepartment of MedicineDuke UniversityDurhamNorth CarolinaUSA
| | - Kristen Campbell
- Maine Medical CenterPortlandMaineUSA
- Department of PharmacyDuke University Medical CenterDurhamNorth CarolinaUSA
| | - Jason I. Koontz
- Division of CardiologyDepartment of MedicineDuke UniversityDurhamNorth CarolinaUSA
| | - Eric J. Velazquez
- Division of CardiologyDepartment of MedicineDuke UniversityDurhamNorth CarolinaUSA
- Section of Cardiovascular MedicineDepartment of Internal MedicineYale UniversityNew HavenConnecticutUSA
| | - Brett D. Atwater
- Division of CardiologyDepartment of MedicineDuke UniversityDurhamNorth CarolinaUSA
- Section of Cardiac ElectrophysiologyInova Heart and Vascular InstituteFairfaxVirginiaUSA
| | - Tristram D. Bahnson
- Division of CardiologyDepartment of MedicineDuke UniversityDurhamNorth CarolinaUSA
| | - James P. Daubert
- Division of CardiologyDepartment of MedicineDuke UniversityDurhamNorth CarolinaUSA
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Holmqvist F, Thomas KL, Broderick S, Ersbøll M, Singh D, Chiswell K, Shaw LK, Hegland DD, Velazquez EJ, Daubert JP. Clinical outcome as a function of the PR-interval-there is virtue in moderation: data from the Duke Databank for cardiovascular disease. Europace 2014; 17:978-85. [PMID: 25164430 DOI: 10.1093/europace/euu211] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Accepted: 07/03/2014] [Indexed: 01/16/2023] Open
Abstract
AIMS Recently, a U-shaped association between PR-interval and the risk of developing atrial fibrillation was described, with higher risk in patients with long and short PR-intervals. Little is known regarding the association of PR-interval duration and mortality. The objective of the current study was to explore the relationship between PR-interval and major cardiovascular outcomes in patients with known coronary heart disease. METHODS AND RESULTS Patients in sinus rhythm, undergoing coronary angiography at Duke University Medical Center between 1989 and 2010, who had significant stenosis in at least one native coronary artery, were included. Patients with arrhythmia, second- or third-degree AV-block, QRS > 120 ms were excluded. A total of 9,637 patients were included (median age 63, IQR 55-71 years, 67% men). After adjustment for relevant covariates, the risk of a CV event increased with a decreasing PR-interval (10 ms decrements) for PR-interval values <162 ms (all-cause mortality; HR 1.057, 95% CI 1.019-1.096, P = 0.0030, composite of death or stroke; HR 1.047, 95% CI 1.011-1.085, P = 0.0095 and composite of cardiovascular death or cardiovascular rehospitalization; HR 1.032, 95% CI 1.002-1.063, P = 0.0387). No statistically significant changes in the risk associated with PR-interval for values >162 ms were seen for any of the studied endpoints. CONCLUSION In patients with coronary heart disease, a prolongation of the PR-interval was not independently associated with poor outcomes, but a PR-interval shorter than normal was associated with increased all-cause mortality and other major cardiovascular events.
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Affiliation(s)
- Fredrik Holmqvist
- Clinical Cardiac Electrophysiology, Duke University Medical Center, Durham, NC, USA Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA
| | - Kevin L Thomas
- Clinical Cardiac Electrophysiology, Duke University Medical Center, Durham, NC, USA Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA
| | - Samuel Broderick
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA
| | - Mads Ersbøll
- Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Devinder Singh
- Clinical Cardiac Electrophysiology, Duke University Medical Center, Durham, NC, USA
| | - Karen Chiswell
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA
| | - Linda K Shaw
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA
| | - Donald D Hegland
- Clinical Cardiac Electrophysiology, Duke University Medical Center, Durham, NC, USA
| | - Eric J Velazquez
- Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - James P Daubert
- Clinical Cardiac Electrophysiology, Duke University Medical Center, Durham, NC, USA Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA
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