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

Alexandra E. Teng, Daniel L. Lustgarten, Pugazhendhi Vijayaraman, Roderick Tung, Kalyanam Shivkumar, Galen S. Wagner, Olujimi A. Ajijola

Research output: Contribution to journalArticlepeer-review

35 Scopus citations

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 (r2 = 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.

Original languageEnglish (US)
Pages (from-to)527-534
Number of pages8
JournalAmerican Journal of Cardiology
Volume118
Issue number4
DOIs
StatePublished - Aug 15 2016
Externally publishedYes

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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