Novel implant technique for septal pacing. A noninvasive approach to nonselective his bundle pacing

2020 ◽  
Vol 63 ◽  
pp. 35-40
Author(s):  
Ortega Daniel ◽  
Logarzo Emilio ◽  
Barja Luis ◽  
Paolucci Analía ◽  
Mangani Nicolás ◽  
...  
Keyword(s):  
His Bundle ◽  
His Bundle Pacing ◽  
Septal Pacing ◽  
Implant Technique

scholarly journals Programmed His bundle pacing - a novel maneuver for the diagnosis of His bundle capture

2018 ◽  
Author(s):  
Marek Jastrzębski ◽  
Paweł Moskal ◽  
Agnieszka Bednarek ◽  
Grzegorz Kiełbasa ◽  
Pugazhendhi Vijayaraman ◽  
...  
Keyword(s):  
Abrupt Change ◽  
Pacemaker Implantation ◽  
Drive Train ◽  
List Type ◽  
His Bundle ◽  
His Bundle Pacing ◽  
Coupling Interval ◽  
Septal Pacing ◽  
Qrs Morphology ◽  
Premature Beats

AbstractBackgroundDuring permanent non-selective (ns) His bundle (HB) pacing, it is crucial to confirm HB capture / exclude that only right ventricle (RV)-myocardial septal pacing is present. Because the effective refractory period (ERP) of the working myocardium is different than the ERP of the HB, we hypothesized that it should be possible to differentiate ns-HB capture from RV-myocardial capture using programmed extra-stimulus technique.MethodsIn consecutive patients during HB pacemaker implantation, programmed HB pacing was delivered from the screwed-in HB pacing lead. Premature beats were introduced at 10 ms steps during intrinsic rhythm and also after a drive train of 600 ms. The longest coupling interval that resulted in an abrupt change of QRS morphology was considered equal to ERP of HB or RV-myocardium.ResultsProgrammed HB pacing was performed from 50 different sites in 32 patients. In 34/36 cases of ns-HB pacing, the RV-myocardial ERP was shorter than HB ERP (271.8±38 ms vs 353.0±30 ms, p < 0.0001). Programmed HB pacing using a drive train resulted in a typical abrupt change of paced QRS morphology: from ns-HB to RV-myocardial QRS (34/36 cases) or to selective HB QRS (2/36 cases). Programmed HB pacing delivered during supraventricular rhythm resulted in obtaining selective HB QRS in 20/34 and RV-myocardial QRS in 14/34 of the ns-HB cases. In RV-myocardial only pacing cases (“false ns-HB pacing”, n=14), such responses were not observed – the QRS morphology remained stable. Therefore, the PHB pacing correctly diagnosed all ns-HB cases and all RV-myocardial pacing cases.ConclusionsA novel maneuver for the diagnosis of HB capture, based on the differences in ERP between HB and myocardium was formulated, assessed and found as diagnostically valuable. This method is unique in enabling to visualize selective HB QRS in patients with otherwise obligatory ns-HB pacing (RV-myocardial capture threshold < HB capture threshold).What this study addsProgrammed His bundle pacing – a novel and straightforward method for unquestionable diagnosis of His bundle capture during non-selective pacing was developed and assessed.A method for visualization of selective HB capture QRS in patients with obligatory non-selective pacing (myocardial capture threshold < His bundle capture threshold) was discovered and physiology behind it explained.

Novelties in cardiac pacing. Left bundle branch pacing, a step-by-step guide

2021 ◽  
Vol 2 (59) ◽  
pp. 27-41
Author(s):  
Marek Jastrzębski
Keyword(s):  
Cardiac Pacing ◽  
Left Ventricular ◽  
Conduction System ◽  
Target Area ◽  
His Bundle ◽  
His Bundle Pacing ◽  
Septal Pacing ◽  
Rotation Technique ◽  
Ventricular Activity ◽  
Pace Mapping

Left bundle branch pacing (LBBP) technique is a new method for conduction system pacing that is useful for both bradyarrhythmia and heart failure indications. LBBP, while less physiological than His bundle pacing, offers several practical advantages. Namely, lower and stable pacing thresholds, good sensing of the intrinsic ventricular activity and easiness in localizing the pacing target. The LBBP method more often than His bundle pacing results in engagement of the conduction system distal to the area of the block. A step-by-step approach to LBBP was described. Attention was given to the following phases of the procedure: 1) localization of the target area on the septum, 2) the lead rotation technique with an interpretation of the lead responses (drill effect, screwdriver effect, entanglement effect), 3) methods for monitoring the lead depth in the septum to avoid perforation (fixation beats, continuous pace mapping, impedance), and 4) methods to differentiate between LBBP and left ventricular septal pacing.

scholarly journals Low Fluoroscopy Permanent His Bundle Pacing Using Electroanatomic Mapping

2019 ◽  
Vol 12 (2) ◽  
Author(s):  
Parikshit S. Sharma ◽  
Henry D. Huang ◽  
Richard G. Trohman ◽  
Angela Naperkowski ◽  
Kenneth A. Ellenbogen ◽  
...  
Keyword(s):  
Electroanatomic Mapping ◽  
His Bundle ◽  
His Bundle Pacing

scholarly journals ST-Segment Changes in Stress-Induced Cardiomyopathy and His Bundle Pacing

2021 ◽  
Vol 7 (1) ◽  
pp. 131-133
Author(s):  
James E. Ip ◽  
Steven M. Markowitz
Keyword(s):  
His Bundle ◽  
His Bundle Pacing ◽  
St Segment

The implantation technique in His-bundle pacing: evolution and perspectives

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_2) ◽  
pp. ii3-ii9
Author(s):  
Wei Hua ◽  
Shu Zhang ◽  
Dejia Huang
Keyword(s):  
Implantation Technique ◽  
His Bundle ◽  
His Bundle Pacing

Selective vs Exclusive: a matter of clearness in His bundle pacing

2021 ◽  
Author(s):  
Giovanni Coluccia ◽  
Michele Accogli ◽  
Pietro Palmisano
Keyword(s):  
His Bundle ◽  
His Bundle Pacing

Physiological (His-bundle or Left Septal) Pacing – Lead Stability Study

2021 ◽  
Vol 30 ◽  
pp. S164
Author(s):  
C. Chow ◽  
P. Crane ◽  
H. Lim ◽  
U. Mohamed
Keyword(s):  
Stability Study ◽  
His Bundle ◽  
Septal Pacing ◽  
Pacing Lead

scholarly journals Can permanent His bundle pacing be safely started by operators new to this technique? Data from a multicenter registry

2021 ◽  
Vol 13 (2) ◽  
pp. 233-234
Author(s):  
C. Chaumont ◽  
N. Auquier ◽  
A. Milhem ◽  
A. Mirolo ◽  
A. Al Arnaout ◽  
...  
Keyword(s):  
His Bundle ◽  
His Bundle Pacing ◽  
Multicenter Registry

His-bundle pacing in CHF-patients with narrow QRS and chronic AF – an upgrade from single-chamber to dual-chamber ICD

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Ciesielski ◽  
A Slawuta ◽  
A Zabek ◽  
K Boczar ◽  
B Malecka ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Clinical Status ◽  
Chronic Atrial Fibrillation ◽  
Dual Chamber ◽  
Icd Implantation ◽  
Single Chamber ◽  
His Bundle ◽  
His Bundle Pacing ◽  
Short Period

Abstract   A single-chamber ICD is a standard method for primary SCD prophylaxis. In patients with chronic atrial fibrillation it does not contribute to the regularization of heart rate, which is crucial for proper treatment. Moreover, to avoid the deleterious effect of right ventricular pacing only minority of the patients with single chamber ICD get the appropriate, recommended dose of beta-blockers. The aim of our study was to assess the efficacy of direct His-bundle pacing in a population of patients with congestive heart failure and chronic atrial fibrillation using upgrade from single chamber to dual-chamber ICD and atrial channel to perform the His-bundle pacing Methods The study population included 39 patients (37 men, 2 women) aged 67.2±9.3 years, with CHF and chronic AF implanted primarily with single chamber ICD with established pharmacotherapy and stable clinical status. Results The echocardiography measurements at baseline and during follow-up were presented in the table: During short period (3–6 months) of follow-up the mean values of EF and LV dimensions significantly improved. This was also accompanied by functional status improvement. Conclusions His-bundle-based pacing in CHF-chronic AF patients contributes to significant echocardiographic and clinical improvement. Standard single-chamber ICD implantation in CHF-chronic AF patients yields only SCD prevention without influence on remodeling process. The physiological pacing contributes to better pharmacotherapy. Funding Acknowledgement Type of funding source: None

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