Three-Dimensional Electro-Anatomical Mapping and Myocardial Work Performance during Spontaneous Rhythm, His Bundle Pacing and Right Ventricular Pacing: The EMPATHY Study

Michele Malagù, Francesco Vitali, Rodolfo Francesco Massafra, Laura Sofia Cardelli, Rita Pavasini, Gabriele Guardigli, Claudio Rapezzi, Matteo Bertini, Michele Malagù, Francesco Vitali, Rodolfo Francesco Massafra, Laura Sofia Cardelli, Rita Pavasini, Gabriele Guardigli, Claudio Rapezzi, Matteo Bertini

Abstract

Background: His bundle pacing (HBP) has emerged as an alternative site to right ventricular pacing (RVP) with encouraging outcomes. To date, no study has investigated the systematic approach of three-dimensional electroanatomic mapping (3D-EAM) to guide HBP implantation and to evaluate myocardial activation timing. Furthermore, studies reporting a comprehensive assessment of the ventricular function, using myocardial work (MW) evaluation are lacking.

Objectives: (1) To evaluate the systematic use of the 3D-EAM as a guide to HBP; (2) to assess the electrical and mechanical activations with high-density mapping, comparing spontaneous ventricular activation (SVA), HBP and RVP; (3) to assess the myocardial function through speckle-tracking echocardiography (STE) and MW analysis in SVA, HBP and RVP.

Methods: 3D-EAM was performed in consecutive patients undergoing HBP implantation with a low use of fluoroscopy. All patients were systematically evaluated with high-density mapping, MW and STE.

Results: Fifteen patients were enrolled, of whom three had an implant failure (20%). RV activation time was not statistically different between SVA and HBP (103 vs. 104 ms, p = 0.969) but was significantly higher in RVP (133 ms, p = 0.011 vs. SVA and p = 0.001 vs HBP). Global constructive work was significantly lower during RVP (1191 mmHg%) than during SVA and HBP (1648 and 1505 mmHg%, p = 0.011 and p = 0.008, respectively) and did not differ between SVA and HBP (p = 0.075).

Conclusions: 3D-EAM and MW evaluation showed that HBP was comparable to the physiological SVA in terms of activation time and cardiac performance. Compared to both SVA and HBP, RVP was associated with a worse activation timing and ventricular efficiency.

Keywords: electromechanical; electrophysiology; pacemaker; physiology; speckle tracking; strain.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Myocardial work. GWI: global work index. GCW: global constructive work. GWW: global wasted work. SVA: spontaneous ventricular activation. HBP: His bundle pacing. RVP: right ventricular pacing.
Figure 2
Figure 2
Myocardial work. GWE: global work efficiency. SVA: spontaneous ventricular activation. HBP: His bundle pacing. RVP: right ventricular pacing.
Figure 3
Figure 3
Pressure strain loops and global longitudinal strain bulls-eye showing the difference in left ventricular activation between spontaneous rhythms, His bundle pacing and right ventricular pacing.
Figure 4
Figure 4
Central illustration. Three dimensional high-density electroanatomical mapping and myocardial work performance during spontaneous rhythm, His bundle pacing and right ventricular pacing. SVA: spontaneous ventricular activation; HBP: His bundle pacing; RVP: right ventricular pacing; RV: right ventricle. p values are considered vs SVA.

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Source: PubMed

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