PO-03-015 HIS BUNDLE PACING: OUTCOME AFTER 10-YEARS FOLLOW-UP

Abstract

His bundle pacing (HBP) ensures a physiologic ventricular activation and can prevent pacing-induced cardiomyopathy. Published experiences confirm good clinical results on short-term follow-up. Data on long-term follow-up are still lacking. to analyze technical and clinical outcomes of HBP in an unselected population after a very long-term follow-up. Retrospective analysis of 370 patients (mean age 75±8 years; 221 males) with standard indication for pacing implanted with HBP from 2003 to 2012. In 52% selective-HBP was obtained while 48% were non selective-HBP. In all cases the HBP was performed by lumenless fixed screw lead and deflectable sheath C304. The indications for pacing were AV block 51%, sinus node disease 22%, atrial fibrillation and slow ventricular rate 25%, heart failure 2%. Ischemic cardiopathy was found in 84 pts (29%); hypertension in 317 pts (86%) and diabetes in 108 pts (29%). Pre-implant QRS was 119±30 ms and basal mean EF 57±11%. The His lead was inserted in ventricular port of CRT-P device in 162 (44%) pts, in atrial port of a DR device in 183 (49%) pts, and in ventricular channel of a SR device in 25 (7%) pts. A back-up lead was implanted in right apex or septum in 203 (55%) patients. All patients were checked once a year. 124 (34%) pts overstepped 10 years follow-up (mean 12.3 ±1.8 years), they were analyzed on technical and clinical performance. At the end of follow-up, the mean EF was 61±8% (P=NS) and the mean paced QRS 123 ± 27 (P=NS). 10 (8%) patients had heart failure hospitalizations. 26 (21%) died after 12.1 ±1.7 years. From a technical point of view, 99 (80%) pts showed good performance of the HBP lead at the last follow-up while 25 (20%) pts experienced lead-related problems: 20 (16%) had HBP lead issues (2 cases of severe HBP malfunction required hospitalization due to syncope) and 5 (4%) had malfunction of the back-up lead. The mean devices longevity was 6.6 ±2.6 years and each patient had 1.5 ±0.8 replacements. It was required to add a back-up catheter in 3.6% of patients. The remaining 205 patients completed a mean follow-up of 6.3±2.7 years while 41(11%) patients were lost at follow-up (died within the first month post-implant or checked in other centres). HBP is safe and feasible in the clinical practice. The system maintains a good performance during a long-term follow-up and ensures a physiologic ventricular contraction thus allowing good clinical outcome. The EF and QRS duration remain in normal values.