{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T21:32:10Z","timestamp":1774647130959,"version":"3.50.1"},"reference-count":24,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2020,10,5]],"date-time":"2020-10-05T00:00:00Z","timestamp":1601856000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000272","name":"National Institute for Health Research","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cardiovasc electrophysiol"],"published-print":{"date-parts":[[2020,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Aims<\/jats:title><jats:p>A prolonged PR interval may adversely affect ventricular filling and, therefore, cardiac function. AV delay can be corrected using right ventricular pacing (RVP), but this induces ventricular dyssynchrony, itself harmful. Therefore, in intermittent heart block, pacing avoidance algorithms are often implemented. We tested His\u2010bundle pacing (HBP) as an alternative.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Outpatients with a long PR interval (&gt;200\u2009ms) and intermittent need for ventricular pacing were recruited. We measured within\u2010patient differences in high\u2010precision hemodynamics between AV\u2010optimized RVP and HBP, as well as a pacing avoidance algorithm (Managed Ventricular Pacing [MVP]).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We recruited 18 patients. Mean left ventricular ejection fraction was 44.3\u2009\u00b1\u20099%. Mean intrinsic PR interval was 266\u2009\u00b1\u200942\u2009ms and QRS duration was 123\u2009\u00b1\u200929\u2009ms. RVP lengthened QRS duration (+54\u2009ms, 95% CI 42\u201367\u2009ms, <jats:italic>p<\/jats:italic>\u2009&lt;\u2009.0001) while HBP delivered a shorter QRS duration than RVP (\u221256\u2009ms, 95% CI \u221267 to \u221246\u2009ms, <jats:italic>p<\/jats:italic>\u2009&lt;\u2009.0001). HBP did not increase QRS duration (\u22122\u2009ms, 95% CI \u22128 to 13\u2009ms, <jats:italic>p<\/jats:italic>\u2009=\u2009.6). HBP improved acute systolic blood pressure by mean of 5.0\u2009mmHg (95% CI 2.8\u20137.1\u2009mmHg, <jats:italic>p<\/jats:italic>\u2009&lt;\u2009.0001) compared to RVP and by 3.5\u2009mmHg (95% CI 1.9\u20135.0\u2009mmHg, <jats:italic>p<\/jats:italic>\u2009=\u2009.0002) compared to the pacing avoidance algorithm. There was no significant difference in hemodynamics between RVP and ventricular pacing avoidance (<jats:italic>p<\/jats:italic>\u2009=\u2009.055).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>HBP provides better acute cardiac function than pacing avoidance algorithms and RVP, in patients with prolonged PR intervals. HBP allows normalization of prolonged AV delays (unlike pacing avoidance) and does not cause ventricular dyssynchrony (unlike RVP). Clinical trials may be justified to assess whether these acute improvements translate into longer term clinical benefits in patients with bradycardia indications for pacing.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jce.14763","type":"journal-article","created":{"date-parts":[[2020,9,25]],"date-time":"2020-09-25T16:24:13Z","timestamp":1601051053000},"page":"2964-2974","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Within\u2010patient comparison of His\u2010bundle pacing, right ventricular pacing, and right ventricular pacing avoidance algorithms in patients with PR prolongation: Acute hemodynamic study"],"prefix":"10.1111","volume":"31","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7472-7358","authenticated-orcid":false,"given":"Daniel","family":"Keene","sequence":"first","affiliation":[{"name":"National Heart and Lung Institute, Imperial College London Hammersmith Hospital London UK"},{"name":"Imperial College Healthcare NHS Trust Hammersmith Hospital London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthew J.","family":"Shun\u2010Shin","sequence":"additional","affiliation":[{"name":"National Heart and Lung Institute, Imperial College London Hammersmith Hospital London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ahran D.","family":"Arnold","sequence":"additional","affiliation":[{"name":"National Heart and Lung Institute, Imperial College London Hammersmith Hospital London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katherine","family":"March","sequence":"additional","affiliation":[{"name":"National Heart and Lung Institute, Imperial College London Hammersmith Hospital London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Norman","family":"Qureshi","sequence":"additional","affiliation":[{"name":"Imperial College Healthcare NHS Trust Hammersmith Hospital London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fu Siong","family":"Ng","sequence":"additional","affiliation":[{"name":"National Heart and Lung Institute, Imperial College London Hammersmith Hospital London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark","family":"Tanner","sequence":"additional","affiliation":[{"name":"Imperial College Healthcare NHS Trust Hammersmith Hospital London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicholas","family":"Linton","sequence":"additional","affiliation":[{"name":"Imperial College Healthcare NHS Trust Hammersmith Hospital London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Phang B.","family":"Lim","sequence":"additional","affiliation":[{"name":"Imperial College Healthcare NHS Trust Hammersmith Hospital London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Lefroy","sequence":"additional","affiliation":[{"name":"Imperial College Healthcare NHS Trust Hammersmith Hospital London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Prapa","family":"Kanagaratnam","sequence":"additional","affiliation":[{"name":"Imperial College Healthcare NHS Trust Hammersmith Hospital London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicholas S.","family":"Peters","sequence":"additional","affiliation":[{"name":"National Heart and Lung Institute, Imperial College London Hammersmith Hospital London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Darrel P.","family":"Francis","sequence":"additional","affiliation":[{"name":"Imperial College Healthcare NHS Trust Hammersmith Hospital London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zachary I.","family":"Whinnett","sequence":"additional","affiliation":[{"name":"National Heart and Lung Institute, Imperial College London Hammersmith Hospital London UK"},{"name":"Imperial College Healthcare NHS Trust Hammersmith Hospital London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2020,10,5]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/0735-1097(94)00419-Q"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa071880"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.288.24.3115"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2013.08.003"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1099-5129(03)00087-4"},{"issue":"2","key":"e_1_2_8_7_1","first-page":"282","article-title":"Reduction in unnecessary ventricular pacing fails to affect hard clinical outcomes in patients with preserved left ventricular function: a meta\u2010analysis","volume":"19","author":"Shurrab 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