His bundle pacing versus left bundle branch pacing on ventricular function in atrial fibrillation patients referred for pacing:a prospective crossover comparison

BACKGROUND His bundle pacing(HBP)and left bundle branch pacing(LBBP)both provide physiologic pacing which maintain left ventricular synchrony.They both improve heart failure(HF)symptoms in atrial fibrillation(AF)patients.We aimed to assess the intra-patient comparison of ventricular function and remodeling as well as leads parameters corresponding to two pacing modalities in AF patients referred for pacing in intermediate term.METHODS Uncontrolled tachycardia AF patients with both leads implantation successfully were randomized to either modality.Echocardiographic measurements,New York Heart Association(NYHA)classification,quality-of-life assessments and leads parameters were obtained at baseline and at each 6-month follow up.Left ventricular function including the left ventricular endosystolic volume(LVESV),left ventricular ejection fraction(LVEF)and right ventricular(RV)function quantified by tricuspid annular plane systolic excursion(TAPSE)were all assessed.RESULTS Consecutively twenty-eight patients implanted with both HBP and LBBP leads successfully were enrolled(69.1±8.1 years,53.6% male,LVEF 59.2%±13.7%).The LVESV was improved by both pacing modalities in all patients(n=23)and the LVEF was improved in patients with baseline LVEF at less than 50%(n=6).The TAPSE was improved by HBP but not LBBP(n=23).CONCLUSION In this crossover comparison between HBP and LBBP,LBBP was found to have an equivalent effect on LV function and remodeling but better and more stable parameters in AF patients with uncontrolled ventricular rates referred for atrioventricular node(AVN)ablation.HBP could be preferred in patients with reduced TAPSE at baseline rather than LBBP.

Three-dimensional echocardiographic assessment of left ventricular volume in different heart diseases using a fully automated quantification software

BACKGROUND HeartModel(HM)is a fully automated adaptive quantification software that can quickly quantify left heart volume and left ventricular function.This study used HM to quantify the left ventricular end-diastolic(LVEDV)and end-systolic volumes(LVESV)of patients with dilated cardiomyopathy(DCM),coronary artery heart disease with segmental wall motion abnormality,and hypertrophic cardiomyopathy(HCM)to determine whether there were differences in the feasibility,accuracy,and repeatability of measuring the LVEDV,LVESV,LV ejection fraction(LVEF)and left atrial end-systolic volume(LAESV)and to compare these measurements with those obtained with traditional twodimensional(2D)and three-dimensional(3D)methods.AIM To evaluate the application value of HM in quantifying left heart chamber volume and LVEF in clinical patients.METHODS A total of 150 subjects who underwent 2D and 3D echocardiography were divided into 4 groups:(1)42 patients with normal heart shape and function(control group,Group A);(2)35 patients with DCM(Group B);(3)41 patients with LV remodeling after acute myocardial infarction(Group C);and(4)32 patients with HCM(Group D).The LVEDV,LVESV,LVEF and LAESV obtained by HM with(HM-RE)and without regional endocardial border editing(HM-NE)were compared with those measured by traditional 2D/3D echocardiographic methods to assess the correlation,consistency,and repeatability of all methods.RESULTS(1)The parameters measured by HM were significantly different among the groups(P<0.05 for all).Compared with Groups A,C,and D,Group B had higher LVEDV and LVESV(P<0.05 for all)and lower LVEF(P<0.05 for all);(2)HM-NE overestimated LVEDV,LVESV,and LAESV with wide biases and underestimated LVEF with a small bias;contour adjustment reduced the biases and limits of agreement(bias:LVEDV,28.17 mL,LVESV,14.92 mL,LAESV,8.18 mL,LVEF,-0.04%).The correlations between HM-RE and advanced cardiac 3D quantification(3DQA)(r_(s)=0.91-0.95,P<0.05 for all)were higher than those between HM-NE(r_(s)=0.85-0.93,P<0.05 for all)and the traditional 2D methods.The correlations between HM-RE and 3DQA were good for Groups A,B,and C but remained weak for Group D(LVEDV and LVESV,r_(s)=0.48-0.54,P<0.05 for all);and(3)The intraobserver and interobserver variability for the HM-RE measurements were low.CONCLUSION HM can be used to quantify the LV volume and LVEF in patients with common heart diseases and sufficient image quality.HM with contour editing is highly reproducible and accurate and may be recommended for clinical practice.