CARDIOVASCULAR JOURNAL OF AFRICA • Volume 34, No 3, July/August 2023 192 AFRICA medication. The left ventricular ejection fraction (LVEF) was 15% at first consultation. He had a ventricular escape of 36/min. He underwent NS-HBP with a QRSd of 115 ms (Fig. 2B). The old RV lead was connected to the RV port and the His lead to the atrial port (Fig. 2C). Post-implant QRSd was 106 ms (Fig. 2D). Four weeks later the LVEF improved from 14 to 28% and NYHA from class III–IV to II. The His-lead parameters were: R wave = 1.4 mV, impedance = 374 Ω, threshold = 2.5 V @ 1.00 ms Patient 2 This patient was a 45-year-old female with post-partum CM, HF with LBBB, QRSd = 156 ms, NYHA class III and LVEF of 25% in sinus rhythm. She underwent a CRT pacemaker (CRT-P) via the right atrium and HBP only (Fig. 3A). Post implant, the QRSd was 130 ms with NS-HBP (Fig. 3B–D). The His-lead parameters were: HBP: R wave = 6.7 mV, impedance = 351 Ω, threshold = 4.4 V @ 1.00 ms; RA: P wave = 2.0 mV, impedance = 556 Ω, threshold = 0.6 V @ 0.5 ms. Patient 3 A 48-year-old male presented with HF with prolonged PR ± 208 ms due to dilated CM (Fig. 4A). He had LBBB with QRSd = 158 ms and left anterior hemiblock (LAHB) with axis deviation at –73°. During His mapping the His-ventricular (HV) was prolonged at 90 ms. The QRSd was reduced from 158 to 140 ms. This was not surprising as there was evidence of infra-Hisian disease (LAHB with QRS axis –73° and HV = 90 ms). The LV lead was therefore implanted and the QRSd was further reduced to 124 ms (Fig. 4B). The other reason to implant the LV lead was the observed prolonged HV interval as well as the left-axis deviation, alluding to the infra-Hisian disease (Fig. 4C). The His-lead parameters were: R wave = 8.9 mV, impedance = 754 Ω, threshold = 1.0 V @ 1.00 ms. Fig. 3. A. Baseline ECG with broad LBBB. B. Post implant before shortening the AV delay. C. AV delay optimisation and final ECG showing NS-HBP with marked narrowing of the QRSd compared to the baseline, as well as the non-optimised QRSd, as shown in Fig. 3B. D. Final images post implant. A C B D Fig. 4. A. Baseline ECG with LBBB with atypical features, namely, Q in V5, S in V5–V6 and left-axis deviation. B. His and LV pacing simultaneously with QRSd = 124 ms. C. The right and left anterior oblique X-rays of patient 3. A B C
RkJQdWJsaXNoZXIy NDIzNzc=