Abstract
Biventricular pacing (BVP) shortens left ventricular activation time (LVAT) in patients with heart failure and left bundle branch block (LBBB). His bundle pacing can correct LBBB (HBP-CRT). The effects of BVP and HBP-CRT on ventricular repolarisation are not known. To measure the effects of HBP-CRT and BVP on LV repolarisation using non-invasive epicardial mapping (ECGI). Participants were recruited in 2 groups. 1) Patients scheduled for BVP for heart failure with LBBB, 2) Individuals with normal QRS and LV function. We defined HBP-CRT as LVAT shortening >10ms. We compared the effects of HBP-CRT and BVP on ECGI-derived dispersion of repolarisation and activation-recovery intervals. 21 HBP-CRT and 21 narrow intrinsic QRS were recruited. LV repolarisation dispersion was reduced by HBP-CRT (-42.0ms, 95%CI: -52.3 to -31.7, p <0.001) but not BVP (11.9ms, -6.2 to 30.1, p=0.182, 18.5ms). Change in LV repolarisation dispersion from BVP to HBP-CRT was -56.5ms (-70.5 to 42.5, p<0.001). LV repolarisation dispersion with HBP-CRT was not different from narrow intrinsic QRS (2.8ms, -16.2 to 21.7, p=0.981). Reduction in LV repolarisation dispersion with HBP-CRT from intrinsic LBBB was similar to LVAT shortening (-45.9ms, 95%CI: -59.3 to -32.4). However, LV activation-recovery interval dispersion was also reduced by HBP-CRT (-56.5 ms, -70.5 to -42.5ms, p<0.001). HBP-CRT can normalise repolarisation dispersion, producing more physiological repolarisation than BVP. This occurs through effects on both activation and action-potential duration. HBP-CRT may prevent ventricular arrhythmias in heart failure with LBBB to a greater extent than BVP.
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