Abstract
Long-term right ventricular pacing (RVP) is associated with more cardiovascular death, atrial fibrillation (AF), thromboembolic complications and heart failure(HF). RVP often results in prolonged QRS duration(QRSd) and ventricular desynchronization. The ventricular desynchronization as a result of RVP leads to an increased risk of heart failure hospitalization (HFH) and AF, and this effect is dependent on cumulative percent ventricular paced ( % VP). In the sub-study from the MOST trial, it was evident that % VP >40% was associated with a 2.6-fold increased risk of HFH compared with pacing < 40% of the time despite preserved atrioventricular synchrony. Moreover this adverse effect of RVP induced ventricular desynchrony was more pronounced in patients with left ventricular ejection fraction( LVEF) of 40% or less resulting in increased death or HFH.
Highlights
Long-term right ventricular pacing (RVP) is associated with more cardiovascular death, atrial fibrillation (AF), thromboembolic complications and heart failure(HF) [1]
In LBBP the AV delay has to be programmed 20–30ms less than the nominal values as it takes 20–30ms for the impulse to reach the ventricular myocardium after LB potential [22].Concerns regarding the theoretical risk of left ventricular (LV)–RV dyssynchrony due to Right Bundle Branch Block (RBBB) induced by LBB area pacing (LBBAP) can be sorted by programming the output above the anodal threshold or optimizing the AV delay to allow native fusion
Does His bundle pacing (HBP) will help in patient of heart failure with reduced ejection fraction (HFrEF) and RBBB was evaluated by Sharma et al [46].In this retrospective observational study it was shown that HBP resulted in a significant narrowing of QRS from 158 ±24 ms to 127 ±17 ms (p=0.0001), with an improvement in LVEF (31 ±10% to 39 ±13%) (p=0.004)
Summary
DR Vivek Kumar*, DR Vanita Arora Indraprastha Apollo Hospitals, New Delhi, India. Received date: November 19, 2021; Accepted date: December 08, 2021; Published date: January 04, 2022.
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