Author + information
- Received November 8, 2005
- Revision received December 12, 2005
- Accepted January 2, 2006
- Published online May 16, 2006.
- Eraldo Occhetta, MD⁎ (, )
- Miriam Bortnik, MD,
- Andrea Magnani, MD,
- Gabriella Francalacci, MD,
- Cristina Piccinino, MD,
- Laura Plebani, PhD and
- Paolo Marino, MD, FESC
- ↵⁎Reprint requests and correspondence:
Dr. Eraldo Occhetta, Divisione Clinicizzata di Cardiologia, Azienda Ospedaliera Maggiore della Carità Corso Mazzini 18, 28100 Novara, Italy.
Objectives The aim of our study was to evaluate the feasibility, the safety, and hemodynamic improvements induced by permanent para-Hisian pacing in patients with chronic atrial fibrillation and narrow QRS who underwent atrioventricular (AV) node ablation.
Background Right ventricular apical pacing, inducing asynchronous ventricular contraction, may impair cardiac function; permanent para-Hisian pacing could preserve interventricular synchrony and improve left ventricular function.
Methods After AV node ablation, 16 patients were implanted with a dual-chamber pacemaker connected to a screw-in lead positioned in close proximity to the His bundle and to a right ventricular apical lead. Clinical and echocardiographic data were collected at baseline and after two randomized six-month periods (with para-Hisian and conventional pacing).
Results During para-Hisian pacing, the interventricular electromechanical delay improved as well (34 ± 18 ms) as during right apical pacing (47 ± 19 ms), p < 0.05. Para-Hisian pacing allowed an improvement in New York Heart Association functional class (1.75 ± 0.4 vs. 2.33 ± 0.6 at baseline and 2.5 ± 0.4 during apical pacing, p < 0.05 for both), in quality-of-life score (16.2 ± 8.7 vs. 32.5 ± 15.0 at baseline, p < 0.05), and in the 6-min walk test (431 ± 73 m vs. 378 ± 60 m at baseline and 360 ± 71 m during apical pacing, p < 0.5 for both). Mitral and tricuspid regurgitation improved during para-Hisian pacing (1.22 ± 0.8 and 1.46 ± 0.5 index, respectively, vs. 1.68 ± 0.6 [p < 0.05] and 1.62 ± 0.7 [p = NS] index at baseline, respectively), with a slight worsening during apical pacing (1.93 ± 1 and 1.93 ± 0.7 index, respectively, p < 0.05 for both).
Conclusions Permanent para-Hisian pacing is feasible and safe. Compared with conventional right apical pacing, it allows an improvement in functional and hemodynamic parameters over long-term follow-up.
- Received November 8, 2005.
- Revision received December 12, 2005.
- Accepted January 2, 2006.
- American College of Cardiology Foundation