Early experience of His bundle pacing as an alternative of chronic right ventricular pacing: Initial and short-term results

Abstract

Right ventricular pacing (RVP) induces ventricular desynchronization in patients with normal QRS and increases the risk of heart failure and atrial fibrillation on long term. His bundle pacing (HBP) is a physiological alternative to RVP. To evaluate feasibility and safety of permanent HBP and to evaluate stability of His capture thresholds at 3 months follow-up. We included all patients who underwent pacemaker implantation with attempt of His bundle pacing in Rouen University Hospital and GH Le Havre between September 2017 and September 2018. Selective His capture was defined as concordance of QRS and T waves complexes with the native ECG (patients with underlying bundle branch block may normalize), presence of a delay between spike and QRS complex, absence of widening of the QRS at a low pacing output, and recordable His bundle electrogram. At 3 months follow-up, His bundle capture thresholds, R-wave amplitudes and pacing impedances were recorded. His bundle capture (HBC) was successful in 35 of 40 patients (87.5%); selective HBC was obtained in 28 patients while nonselective HBC occurred in 7 patients. Indication for pacemaker implantation was atrioventricular conduction disease in 18 patients (45%), sinus node dysfunction in 4 patients (10%) and AV nodal ablation for non-controlled atrial arrhythmias in 18 patients (45%). AV nodal ablation was performed during the same procedure in 12 patients. Mean procedure duration was 74 ± 10 min, and mean fluoroscopy duration was 10.3 ± 7 min. Mean His bundle capture threshold was 1.37 ± 0.3 V and did not increase after a 3 months follow-up (1.02 ± 0.3 V). Only 2 patients had His capture threshold > 2 V/0.5ms. There was no pericardial effusion, no pneumothorax, no device infection and no ventricular lead revision required at 3 months ( Fig. 1 ). His bundle pacing was feasible and safe after a one-year experience. His bundle capture thresholds slightly decreased at 3 months follow-up.