Permanent His bundle pacing can be safely started in centres with lack of experience of this technique: Results from a French multicentric registry

Abstract

Right ventricular pacing (RVP) induces ventricular asynchrony in patients with normal QRS and increases the long term risk of heart failure and atrial fibrillation. His bundle pacing (HBP) is a physiological alternative to RVP. Interest in HBP has been hampered by technical challenges and limited implantation tool set. Recent studies assessed feasibility and safety of HBP in expert centres. These results may not apply to less experienced centres. To evaluate feasibility and safety of permanent His bundle pacing in hospitals with limited technical training to this technique and to evaluate stability of His Bundle capture (HBC) thresholds. We included all patients who underwent pacemaker implantation with attempt of HBP in 3 hospitals between September 2017 and December 2019. All the 6 operators were novice for HBP. HPB was successful in 134 of 154 patients (87.0%); selective HBP was obtained in 93 patients while non-selective HBP occurred in 41 patients. Indication for pacemaker implantation was AV conduction disease in 74 patients (48%), sinus node dysfunction in 30 patients (19.5%) and AV nodal ablation for non-controlled atrial arrhythmias in 50 (32.5%). The mean procedure duration was 68.2 ± 30.2 min, and the mean fluoroscopy duration was 7.5 ± 8.5 min (3.06 ± 1.01 Gy.cm 2 ). The mean HBC threshold was 1.28 ± 0.84V@0.5ms and did not increase at 3 months (1.26 ± 0.88V@0.5ms) and 12 months (1.25 ± 0.79V@0.5ms) follow-up. Ventricular lead revision was required at 3 months in two patients for sudden threshold increase without obvious lead dislodgement and at one month in one patient for lead dislodgement. There was no pericardial effusion, no pneumothorax and no device infection ( Fig. 1 ). His Bundle pacing performed by novice operators to this technique appeared feasible and safe. The mean HBC threshold did not increase at 3 months and one-year follow-up.