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J Am Coll Cardiol, 2006; 47:1938-1945, doi:10.1016/j.jacc.2006.01.056 (Published online 20 April 2006).
© 2006 by the American College of Cardiology Foundation
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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.


Figure 1
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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.

 

Figure 2
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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.

 

Figure 3
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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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Copyright © 2006 by the American College of Cardiology Foundation.