Electrograms guided his bundle pacing implant: moving from radiology to electrical signals

Abstract

Abstract Background The standard technique to His Bundle Pacing (HBP) based on a fluoroscopic approach might be challenging and fluoro consuming. The electrical signals could lead to a precise and rapid lead implant, thus reducing the fluoroscopy time (FT) and X-ray dose. Objective To evaluate the feasibility, efficacy and safety of the electrogram-guided technique to obtain His Bundle pacing (HBP) with minimal or no fluoroscopy use. Methods Between October and December 2018, 41 consecutive patients with indication for pacing underwent HBP with the electrogram-guided approach. Results Successful HBP was obtained in 39/41 (95%) pts, which is the study population (mean age 78±10 years). S-HBP and NS-HBP were achieved in 23 (59%) and 16 (41%) pts, respectively. Final HBP lead position was achieved in 31/39 (79.4%) pts with zero fluoroscopy, only guided by the electrical signals. In the remaining 8 pts a minimal dose of fluoro (mean 8 sec) has been required to locate the His. Fluoroscopy has been routinely used to remove the sheath and to ensure the slack. The atrial lead has been implanted in a standard fashion. No difference was observed in the FT for HBP lead placement in patients with S-HBP and NS-HBP (mean 8.1±25 sec vs 7.5±20 sec, p=0.8; median value 0 sec vs 0 sec). Moreover, no significant differences were observed in the FT needed for the entire procedure, total Dose Area Product (DAP) and total procedural time among both S-HBP and NS-HBP. The His lead dislodgement occurred in 1 (2.6%) patient one day after the procedure. Conclusion HBP could be performed safely and efficiently using the electrograms, with minimal or no fluoroscopy. Fluoroscopy was required during sheath removal and atrial lead placement. Funding Acknowledgement Type of funding source: None