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Date Published: 25/08/2023
Abstract Views: 102
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DOI: https://doi.org/10.51298/vmj.v529i1.6294
Issue
Vol. 529 No. 1 (2023)
Section
Các bài báo
How to Cite
Kiều, N. D., Nguyễn, T. T., & Hoàng, A. T. (2023). AV INTERVAL OPTIMIZATION FOR HIS BUNDLE PACING DEVICES. Vietnam Medical Journal, 529(1). https://doi.org/10.51298/vmj.v529i1.6294

AV INTERVAL OPTIMIZATION FOR HIS BUNDLE PACING DEVICES

Ngọc Dũng Kiều1, Tri Thức Nguyễn1,, Anh Tiến Hoàng2
1 Hue University of Medicine and Pharmacy
2 Cho Ray hospital

Main Article Content

Abstract

Heart failure is a medical condition caused by various underlying medical issues, with arrhythmia being a common issue among patients. Recently, it has been confirmed that electrical abnormalities of the heart can induce myocardiopathy and heart failure. Five types of electrical abnormalities confirmed to cause heart failure are: atrial fibrillation, atrial tachycardia, ventricular premature contractions, ventricular tachycardia and loss of atrial - ventricular synchronization. These electrical abnormalities cause heart failure through various pathological mechanisms such as irregulalopathy, tachymyopathy, AV-uncoupling, and Dyssynchronopathy, leading to cardiac remodeling and heart failure2. In patients with a pacemaker, ventricular dyssynchronisation, atrioventricular uncoupling (if the atrioventricular conduction interval is suboptimal) may occur. To minimize the risk of developing heart disease due to right ventricular pacing, the following methods can be chosen: (1) prioritize ventricular rate control, (2) reducing right ventricular pacing by device programmation, (3) Implanting cardiac resynchronization deives and (4) optimizing atrium – ventricle coupling interval. A new pacing method, the His-bundle pacing device, has been developed and has many advantages in maintaining ventricular synchrony. Especially in patients with widened QRS after cardiac resynchronization therapy, it is necessary to consider combining His bundle pacing and optimize the atrioventricular conduction interval to narrow the QRS and improve clinical outcomes. We present a clinical case where a patient was indicated for a cardiac resynchronization therapy (CRT) device implantation, but after the implantation, the QRS widened by 45ms causing poor response. The patient was then switched to His-paced (HOT-CRT) therapy and underwent optimization of the interval of atrium-ventricle conduction, which helped to narrow the QRS by 20ms compared to previous implantation and 65ms compared to CRT pacing, resulting in improved heart failure symptoms and left ventricular function for the patient.

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References

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