B-PO02-046 DOUBLE SHEATH-DOUBLE LEAD TECHNIQUE TO OVERCOME DIFFICULT CASES OF HIS BUNDLE LEAD IMPLANTATION

Abstract

Although His bundle pacing (HBP) can be accomplished in most patients using a single C315His sheath and a single lead (SS-SL) technique, in some patients this approach could be unsuccessful. To develop a double sheath double lead ( DS-DL ) technique to increase success in achieving permanent HBP when facing difficult cases. Single center prospective cohort study that enrolled consecutive patients in whom 3 or more initial HBP attempts using the SS-SL technique have failed in spite of recording and/or capturing the His bundle. Instead of removing the lead from the last inserted site, this lead (L1) was left in place and used as a fixed anatomical radiographic reference. Subsequently, a second Medtronic C315HIS sheath and a second Medtronic SelectSecure™ Model 3830 lead (L2) were introduced to re-initiate the search for a better site around the tip of L1. Depending on the results obtained with L2, either lead can be removed and placed around the tip of other lead (Panels A and B of figure 1). These steps could be repeated in a systematic fashion until achieving adequate thresholds for HBP or declaring the attempts unsuccessful. The lead that was not used for HBP was then placed in the right atrium if indicated (Panel C). The patients had follow-up evaluations at 3, 6, and 12 months post implantation. Eighteen patients were enrolled, mean age 77 ± 10 yrs (10 males). The DS-DL technique was successfully applied to all patients. (See panel D and E of figure 1). This study demonstrated that the DS-DL technique proved to be safe, feasible and highly efficient in achieving permanent HBP in patients in whom the SS-SL technique have failed to achieve a successful implant.