COMPARISON OF ACUTE HEMODYNAMIC RESPONSE AND UHF-ECG VENTRICLE DEPOLARIZATION IN HIS BUNDLE PACING AND RIGHT VENTRICLE PACING IN PATIENTS WITH BRADYCARDIA.

Goal

To prove a correlation between the effectivity of work of the left ventricle assessed with invasive blood pressure measurement and dyssynchrony assed with ultra-high frequency ECG in bradycardia patients during right ventricle pacing (RVP) and His bundle pacing (HBP).

Methods

This is a preliminary analysis of the first 6 patients. Patients with indications to bradycardia pacing were screened to enter the study. Exclusion criteria were: structural heart disease, CAD, atrial fibrillation, and QRS prolongation.
Before the procedure arterial line for invasive blood pressure measurement was placed in the radial artery. During the implant procedure, two pacing leads were placed: 1/ standard pacing lead in the right ventricle outflow tract (RVOT) and 2/ lumen-less lead capturing the His bundle. UHF-ECG activation map was obtained for both types of capture and e-dys was calculated. Using a structured protocol, the hemodynamic response was compared between myocardial capture in RVOT and HBP. The correlation between hemodynamic response and dyssynchrony measured with UHF-ECG was assessed.

Results

The average e-dys for HBP was 16 ms and was shorter than the average e-dys for RVP, which was 60 ms. Systolic blood pressure was on average 8 mmHg higher in HBP. The correlation coefficient between blood pressure measurement and e-dys was 0,92 (p=0,027).

Conclusion

Invasive blood pressure measurement and dyssynchrony assed with ultra-high frequency ECG show an excellent correlation in the first 6 patients with bradycardia. Dyssynchrony was lower and systolic blood pressure was higher in His bundle pacing than in right ventricle pacing.