Acute echocardiographic and hemodynamic response to his-bundle pacing in patients with first-degree atrioventricular block

Zak Loring, Fredrik Holmqvist, Edward Sze, Fawaz Alenezi, Kristen Campbell, Jason I. Koontz, Eric J. Velazquez, Brett D. Atwater, Tristram D. Bahnson, James P. Daubert

Research output: Contribution to journalArticlepeer-review


Background: Atrial pacing and right ventricular (RV) pacing are both associated with adverse outcomes among patients with first-degree atrioventricular block (1°AVB). His-bundle pacing (HBP) provides physiological activation of the ventricle and may be able to improve both atrioventricular (AV) and inter-ventricular synchrony in 1°AVB patients. This study evaluates the acute echocardiographic and hemodynamic effects of atrial, atrial-His-bundle sequential (AH), and atrial-ventricular (AV) sequential pacing in 1°AVB patients. Methods: Patients with 1°AVB undergoing atrial fibrillation ablation were included. Following left atrial (LA) catheterization, patients underwent atrial, AH- and AV-sequential pacing. LA/left ventricular (LV) pressure and echocardiographic measurements during the pacing protocols were compared. Results: Thirteen patients with 1°AVB (mean PR 221 ± 26 ms) were included. The PR interval was prolonged with atrial pacing compared to baseline (275 ± 73 ms, p =.005). LV ejection fraction (LVEF) was highest during atrial pacing (62 ± 11%), intermediate with AH-sequential pacing (59 ± 7%), and lowest with AV-sequential pacing (57 ± 12%) though these differences were not statistically significant. No significant differences were found in LA or LV mean pressures or LV dP/dT. LA and LV volumes, isovolumetric times, electromechanical delays, and global longitudinal strains were similar across pacing protocols. Conclusion: Despite pronounced PR prolongation, the acute effects of atrial pacing were not significantly different than AH- or AV-sequential pacing. Normalizing atrioventricular and/or inter-ventricular dyssynchrony did not result in acute improvements in cardiac output or loading conditions.

Original languageEnglish
JournalAnnals of Noninvasive Electrocardiology
Issue number4
Early online date2022
Publication statusPublished - 2022

Subject classification (UKÄ)

  • Cardiac and Cardiovascular Systems

Free keywords

  • echocardiography
  • EP study
  • first-degree AV-block
  • His-bundle
  • pacing


Dive into the research topics of 'Acute echocardiographic and hemodynamic response to his-bundle pacing in patients with first-degree atrioventricular block'. Together they form a unique fingerprint.

Cite this