Hisian area and right ventricular apical pacing differently affect left atrial function: an intra-patients evaluation

Europace. 2014 Jul;16(7):1033-9. doi: 10.1093/europace/eut436. Epub 2014 Jan 27.


Aims: Right ventricular apex (RVA) pacing has adverse effects on left atrial (LA) function and may contribute to atrial arrhythmias. The effects of Hisian area (HA) pacing on LA function are still lacking. The objective of this study is to assess the left ventricular (LV) electromechanical activation/relaxation, systolic (S), diastolic (D) phases, and their effects on LA function during pacing from HA and RVA.

Methods and results: Thirty-seven patients with normal cardiac function underwent permanent HA pacing. In all patients, a RVA backup lead was added. The patients first underwent 3 months of HA pacing, followed by 3 months of RVA pacing. After each 3-month period, we compared by echocardiography: S-D LV electromechanical delay (S-D EMD), S-D intra-LV dyssynchrony, LV S-D phases, and their function evaluated by myocardial performance index (MPI) and mitral annular tissue Doppler early diastolic velocity (E'), pulmonary arterial systolic pressure (PASP), and LA function (LA phasic volumes and their emptying fraction). Right ventricular apex compared with HA pacing increased S-D EMD (P < 0.001) and intra-LV dyssynchrony (P < 0.001). As a consequence, a significant longer LV isovolumetric contraction time (P < 0.001) and LV isovolumetric relaxation time (P = 0.05) were measured during RVA compared with HA pacing, whereas LV ejection time was shorter (P = 0.033). Moreover, HA pacing resulted in significantly better MPI (P = 0.039), higher value of E' (P = 0.049), and lower PASP (P < 0.001). Finally, RVA compared with HA pacing was associated to higher LA volumes pre-atrial contraction (P = 0.001) and minimal volume (P = 0.003) with reduction in passive emptying fraction (P < 0.001) and total emptying fraction (P = 0.005).

Conclusion: Hisian area compared with RVA pacing resulted in a more physiological LV electromechanical activation/relaxation and consequently better LA function.

Keywords: Diastolic function; Hisian area pacing; Left atrial function; Left ventricular electromechanical activation; Left ventricular electromechanical relaxation; Right ventricular apical pacing.

Publication types

  • Comparative Study

MeSH terms

  • Aged
  • Atrial Function, Left*
  • Atrioventricular Block / diagnosis
  • Atrioventricular Block / physiopathology
  • Atrioventricular Block / therapy*
  • Bundle of His / physiopathology*
  • Cardiac Pacing, Artificial / adverse effects
  • Cardiac Pacing, Artificial / methods*
  • Echocardiography, Doppler, Color
  • Echocardiography, Doppler, Pulsed
  • Electrocardiography
  • Female
  • Heart Ventricles / diagnostic imaging
  • Heart Ventricles / physiopathology*
  • Hemodynamics
  • Humans
  • Male
  • Middle Aged
  • Myocardial Contraction
  • Stroke Volume
  • Time Factors
  • Treatment Outcome
  • Ventricular Dysfunction, Left / etiology
  • Ventricular Dysfunction, Left / physiopathology
  • Ventricular Function, Left*
  • Ventricular Function, Right*