Abstract
A 79-year-old man with chronic atrial fibrillation underwent single-chamber His-bundle pacemaker implantation. The post-implant electrocardiogram (ECG) demonstrated selective His-bundle capture, with a narrow paced QRS and repolarization pattern similar to that of the baseline ECG. Furthermore, repolarization changes prototypic of ventricular pacing did not occur with selective His-bundle capture. While His-bundle pacing, with or without selective His-bundle capture, can preserve physiologic patterns of depolarization, only His-bundle selective pacing can preserve intrinsic ST- and T-wave patterns. Thus, the maintenance of physiologic repolarization may have various advantages, including accurate interpretation of ECG changes that are not generally interpretable in the setting of ventricular pacing.
Highlights
A 79-year-old man with chronic atrial fibrillation underwent single-chamber His-bundle pacemaker implantation
His-bundle permanent pacing has been promoted as a means to preserve physiologic conduction with ventricular pacing, with the potential to avoid pacing-induced dyssynchrony and ventricular dysfunction.[1]
Permanent His-bundle pacing has been associated with improvements in exercise capacity, left ventricular ejection fraction, and heart failure hospitalizations, as compared with right ventricular pacing.[2,3]
Summary
A 79-year-old man with chronic atrial fibrillation underwent single-chamber His-bundle pacemaker implantation. His-bundle pacing, physiologic conduction, repolarization, selective His-bundle pacing. An echocardiogram demonstrated normal biventricular function, with severe left atrial enlargement, and a 12-lead electrocardiogram (ECG) revealed atrial tachycardia with a slow ventricular rate and a narrow QRS with chronic ST abnormalities (Figure 1).
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