Feasibility Of His Bundle Pacing Research Articles

Feasibility of His bundle pacing and atrioventricular junction ablation with left bundle branch area pacing as backup

Feasibility of His bundle pacing and atrioventricular junction ablation with left bundle branch area pacing as backup

His bundle pacing in nodal versus infranodal atrioventricular block: a mid-term follow-up study

IntroductionThis study evaluated the feasibility of His bundle pacing (HBP) in consecutive, unselected patients with advanced atrioventricular block (AVB) over a medium-term follow-up period, comparing procedural characteristics between nodal and...

Feasibility of His bundle pacing facilitated by EASI derived 12‑lead ECG

IntroductionHis bundle pacing (HBP) has become popular in recent years as a more physiological alternative to conventional right ventricular pacing. Implantation requires 12‑lead ECG during surgery, which is not readily available in a standard operating room. Often but not always HBP is performed in an electrophysiology lab. EASI is a reduced lead system which enables derived 12‑lead ECG. EASI derived 12‑lead ECGs on modern tablet computers offer a more mobile and lightweight ECG solution which does not obstruct fluoroscopy during implantation. This case series aims to compare standard 12‑lead ECG to EASI derived 12‑lead ECG in patients undergoing HBP implantation. Methods and resultsA total of 11 patients received permanent HBP guided only by fluoroscopy, a pacing system analyzer (Medtronic CareLink SmartSync Device Manager) and EASI derived 12‑lead ECG (CardioSecur Pro). During the first postoperative device interrogation HBP criteria, as defined in the EHRA consensus paper on conduction system pacing, were evaluated with the EASI derived system as well as a standard 12‑lead ECG and compared to each other. There was perfect agreement with regards to these criteria which lead to identical conclusions in all cases. ConclusionHBP implantation can be performed with EASI derived 12‑lead ECG instead of conventional 12‑lead ECG. Criteria for discriminating between selective His bundle, non-selective His bundle or myocardial capture alone are clearly visible in the EASI derived ECG leading to the same conclusion when compared to standard 12‑lead ECG. Compared to a conventional 12‑lead ECG the EASI system offers a leaner setup with less visual obstruction on fluoroscopy.

B-AB10-05 PERMANENT DISTAL HIS BUNDLE PACING VIA PERSISTENT LEFT SUPERIOR VENA CAVA

His-purkinje conduction system pacing is widely used as a physiological pacing. Persistent left superior vena cava (PLSVC) is a relatively rare anatomic variation in clinic. Due to the distortion of its venous access, it is a challenge for operator to achieve precise His bundle pacing. Our study aimed to evaluate the feasibility of His bundle pacing in patients with PLSVC. N/A A 57-year-old female who had the indication of pacemaker implantation with sick sinus syndrome and paroxysmal atrial tachycardia was performed with His bundle pacing. PLSVC was found during the operation. The 3830-69 lead was used through C315HIS sheath (Medtronic Inc, Minneapolis, MN, USA) at first. However, either His bundle pacing or left bundle branch area pacing failed. Then we tried the 5076-58 active helix lead by adjusting the steel wire to double-curve shape in reverse and precisely located to His bundle. After electrode fixation, His potential and R wave with current of injury could be recorded, unipolar pacing at 0.5V/0.5ms captured only ventricular endocardium, and increased output at 1.0V/0.5ms captured His (in Fig). The R wave amplitude was 5.6mV and impedance was 570 Ω. The intraoperative electrophysiological characteristics, pacing parameters, UCG and CTA 3D reconstruction all indicated that the electrode was fixed to the ventricular side across the tricuspid valve. The threshold of His bundle was 0.5V/0.5ms on the first day after operation, and increased to 1.5V/0.5ms at two months follow-up. His bundle pacing was successfully achieved by 5076 active lead in the patient, which showed the conventional lead can achieve distal His bundle pacing via PLSVC.

Safety and Feasibility of His-Bundle Pacing: An Australian Experience

Safety and Feasibility of His-Bundle Pacing: An Australian Experience

GW28-e1237 Feasibility of His Bundle Pacing to Correct Left Bundle Branch Block in Heart Failure Patients

Heart failure (HF) patients (pts) with left bundle branch block (LBBB) are indicated for cardiac resynchronization therapy (CRT) that paces left and right ventricles almost at the same time. This study explored the feasibility of correction of LBBB by His bundle pacing (HBP) in HF pts. A total of

Permanent His-bundle pacing in patients with prosthetic cardiac valves

Conduction disease is not uncommon after prosthetic valve (PV) surgery. The feasibility of His-bundle pacing (HBP) in this patient population is not well studied. The purpose of this study was to report our experience with permanent HBP in patients undergoing pacemaker implantation after PV surgery. Permanent HBP was attempted in patients with AV conduction disease after PV surgery referred for pacemaker implantation. Conduction disease was characterized as AV nodal vs infranodal. Feasibility, relationship of HBP lead to PVs, and HBP characteristics were recorded. Thirty patients (47% men, age 74 ± 12 years, left ventricular ejection fraction 49% ± 11%) with AV conduction disease (100% patients; 14 with infranodal block; right bundle branch block 9, left bundle branch block 5, intraventricular conduction delay 1) underwent HBP. PVs included aortic valve replacement (AVR) in 8 patients (infranodal block 6 patients), tricuspid valve (TV) ring with mitral valve replacement or repair (MVR) in 10 patients (AV nodal block 9 patients), transcatheter aortic valve replacement (TAVR) in 4 patients (infranodal block 4 patients), and MVR alone in 6 patients. HBP was successful in 28 patients (93%) (selective HBP 50%). His bundle (HB) recruitment was unsuccessful in 2 patients with TAVR. AVR/TAVR and TV ring served as anatomic landmarks for localizing the HB. Successful sites of HBP were posterior and inferior to AVR/TAVR and distal and septal to the TV ring. Baseline QRSd improved from 124 ± 32 ms to 118 ± 20 ms (P = .39). HBP threshold at implant was 1.45 ± 1 V at 1 ms. Permanent HBP was feasible in 93% of patients with PVs. Patients with AVR/TAVR predominantly developed infranodal block compared to AV nodal block in patients with TV ring/MVR. Location of PV might serve as a landmark for identifying the site of the HB.

Feasibility of His Bundle Pacing as an Alternative Pacing Site: Measurement of His Refractoriness

Direct pacing of the His bundle has been proposed for permanent pacing to maintain physiological synchrony of ventricular activation. Measurement of His bundle refractoriness may be useful in predicting suitability of this technique in an individual. We sought to determine whether this could be measured consistently in patients, defining a normal range. His bundle pacing was performed in 20 consecutive patients (mean age 44.6 +/- 19.5, 5 male) undergoing electrophysiology study. Incremental and extrastimulus testing were performed from the His region to determine effective and functional refractory periods of the His bundle. Consistent His capture was possible in 18 of 20 (90%) patients studied. Extrastimulus testing from the His region at a drive cycle length of 600 msec was successful in all of these patients. With loss of His capture, QRS duration prolonged 32%, and stimulus to atrial electrogram interval prolonged 49.6 +/-16.3 msec. The effective refractory periods at drive cycle lengths 600, 500, and 400 msec were 407 +/- 70 msec, 320 +/- 39 msec, and 336 +/- 54 msec, respectively. Corresponding functional refractory periods were 414 +/- 62, 371 +/- 52, and 329 +/- 32. Consistent capture with incremental His pacing was possible in 50% of patients, and 1:1 His capture was lost at mean cycle length 408 +/-93 msec. His refractory periods can be determined consistently in unselected individuals undergoing electrophysiological studies. Measurement of HERP and HFRP may prove useful in assessing the suitability of the His bundle for permanent pacing.