Prevention of Ventricular Desynchronization by Permanent Para-Hisian Pacing After Atrioventricular Node Ablation in Chronic Atrial Fibrillation
A Crossover, Blinded, Randomized Study Versus Apical Right Ventricular Pacing
Eraldo Occhetta, MD*,
Miriam Bortnik, MD,
Andrea Magnani, MD,
Gabriella Francalacci, MD,
Cristina Piccinino, MD,
Laura Plebani, PhD and
Paolo Marino, MD, FESC
Divisione Clinicizzata di Cardiologia, Facoltà di Medicina e Chirurgia di Novara, Università degli Studi del Piemonte Orientale, Novara, Italy.
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Figure 1 Patient #6. Right anterior oblique (RAO) and left anterior oblique (LAO) fluoroscopic projections showing leads position during the "ablate and pace" procedure and Hisian pacing; 1 = quadripolar Hisian mapping catheter; 2 = screw-in bipolar lead positioned in close proximity to the His-bundle; 3 = bipolar passive fixation positioned in right ventricular apex.
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Figure 2 Patient #6. 12-lead surface electrocardiogram: (A) after atrioventricular node radiofrequency ablation: chronic atrial fibrillation with nodal escape rhythm (QRS 100 ms); (B) during direct His-bundle pacing: paced QRS duration 100 ms, with morphology and electric axis equal to the native QRS; (C) during right apical ventricular pacing: paced QRS duration 160 ms, with extreme left-axis deviation and "left bundle branch block" morphology.
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Figure 3 Interventricular mechanical delay (ms) during para-Hisian (His) and apical (Apex) pacing in 11 patients evaluated with Doppler echocardiography: comparison between pre-ejection aortic and pulmonary times.
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