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Open Access 07-04-2022 | Rhythm Puzzle – Answer

Cardiac resynchronisation therapy in optima forma

Auteurs: S. A. J. Timmer, T. Germans

Gepubliceerd in: Netherlands Heart Journal | Uitgave 5/2022

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Answer

The electrocardiogram in Fig. 2 shows atrioventricular (AV) sequential pacing at a rate of 60 bpm with QRS duration ~90 ms. The QRS morphology is consistent with conduction system pacing, in particular selective His bundle pacing (HBP) with correction of LBBB.
HBP is a cardiac pacing technique with the potential of preserving or restoring normal His-Purkinje activation in the presence of AV conduction block or BBB. A prerequisite for successful HBP in the setting of LBBB is the presence of a proximal or intra-His conduction block, which can be circumvented by pacing the distal His bundle and thereby recruiting the otherwise ‘healthy’ left-sided conduction system. LBBB can be corrected with HBP in up to 80% of patients depending on the site of the block [1], and the conduction block site correlates reasonably well with surface ECG. The Strauss criteria have a positive predictive value of 71% for identifying patients eligible for corrective HBP [2]. Although, as of yet, there is no clear benefit of HBP over traditional biventricular pacing because this has not been investigated properly, HBP is potentially the ultimate form of cardiac resynchronisation therapy [3].
In our patient, pathological Q waves in the inferior and lateral leads, which were previously not visible (see Fig. 1), were revealed postoperatively in conjunction with a dominant R wave in the right precordial leads (Fig. 2), as a result of normalisation of ventricular electrical activation. These ECG findings could be related to the findings of cardiac magnetic resonance imaging (MRI), which revealed transmural inferolateral myocardial infarction (Fig. 3).

Conflict of interest

S.A.J. Timmer is consultant for Medtronic. T. Germans declares that he has no competing interests.
Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://​creativecommons.​org/​licenses/​by/​4.​0/​.
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Netherlands Heart Journal

Het Netherlands Heart Journal wordt uitgegeven in samenwerking met de Nederlandse Vereniging voor Cardiologie. Het tijdschrift is Engelstalig en wordt gratis beschikbaa ...

Literatuur
1.
go back to reference Moriña-Vázquez P, Moraleda-Salas MT, Manovel-Sánchez AJ, et al. Early improvement of left ventricular ejection fraction by cardiac resynchronization through His bundle pacing in patients with heart failure. Europace. 2020;22:125–32.PubMed Moriña-Vázquez P, Moraleda-Salas MT, Manovel-Sánchez AJ, et al. Early improvement of left ventricular ejection fraction by cardiac resynchronization through His bundle pacing in patients with heart failure. Europace. 2020;22:125–32.PubMed
2.
go back to reference Upadhyay GA, Cherian T, Shatz DY, et al. Intracardiac delineation of septal conduction in left bundle-branch block patterns. Circulation. 2019;139:1876–88.CrossRef Upadhyay GA, Cherian T, Shatz DY, et al. Intracardiac delineation of septal conduction in left bundle-branch block patterns. Circulation. 2019;139:1876–88.CrossRef
3.
go back to reference Upadhyay GA, Vijayaraman P, Nayak HM, et al. On-treatment comparison between corrective his bundle pacing and biventricular pacing for cardiac resynchronization: a secondary analysis of the his-SYNC pilot trial. Heart Rhythm. 2019;16:1797–807.CrossRef Upadhyay GA, Vijayaraman P, Nayak HM, et al. On-treatment comparison between corrective his bundle pacing and biventricular pacing for cardiac resynchronization: a secondary analysis of the his-SYNC pilot trial. Heart Rhythm. 2019;16:1797–807.CrossRef
Metagegevens
Titel
Cardiac resynchronisation therapy in optima forma
Auteurs
S. A. J. Timmer
T. Germans
Publicatiedatum
07-04-2022
Uitgeverij
Bohn Stafleu van Loghum
Gepubliceerd in
Netherlands Heart Journal / Uitgave 5/2022
Print ISSN: 1568-5888
Elektronisch ISSN: 1876-6250
DOI
https://doi.org/10.1007/s12471-022-01683-x

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