scholarly journals Retrograde penetration pacing into the conduction system as an alternative approach of his-bundle pacing

2021 ◽  
Author(s):  
Kohei Ishibashi ◽  
Kenichiro Yamagata ◽  
Keisuke Kiso ◽  
Yoshifumi Nouno ◽  
Nobuhiko Ueda ◽  
...  
Keyword(s):  
Conduction System ◽  
His Bundle ◽  
His Bundle Pacing ◽  
Alternative Approach

Anatomic, Radiologic and Electrocardiographic Considerations for Conduction System Pacing

2021 ◽  
Vol 2 (59) ◽  
pp. 8-16
Author(s):  
Paweł Moskal ◽  
Marek Jastrzębski
Keyword(s):  
Conduction System ◽  
University Hospital ◽  
His Bundle ◽  
His Bundle Pacing ◽  
Implantation Techniques ◽  
The University

His bundle pacing and left bundle branch pacing are complementary implantation techniques that combine into conduction system pacing, which allows maintaining or recovering physiological activation of the heart. We selected cases from the electrophysiological laboratory of the University Hospital in Krakow to present theoretical and practical aspects of conduction system pacing using fluoroscopy images, ECG and EGM recordings.

scholarly journals Activation pattern during his pacing: how close are we to normal physiology?

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
O Yasin ◽  
V Vaidya ◽  
J Tri ◽  
M Van Zyl ◽  
A Ladejobi ◽  
...  
Keyword(s):  
Sinus Rhythm ◽  
Left Ventricular ◽  
Conduction System ◽  
Funding Source ◽  
Activation Pattern ◽  
His Bundle ◽  
His Bundle Pacing ◽  
Surface Ecg ◽  
Qrs Duration ◽  
The Right

Abstract Background His bundle pacing aims to mimic the activation pattern of normal conduction to maintain ventricular synchrony. However, selective His capture can be challenging, and the activation sequence during His pacing may not replicate normal conduction. Purpose Compare the right ventricular (RV) and left ventricular (LV) activation pattern in sinus rhythm and His bundle pacing. Methods Baseline LV and RV map was created in sinus rhythm using Rhythmia mapping system (Boston Scientific Corporation) in canine animal model. Medtronic 3830 lead was placed near the bundle of His under fluoroscopic, intracardiac echocardiogram, and electroanatomic guidance. Conduction system capture was confirmed by observing a QRS duration <120ms and an isoelectric segment between pacing artifact and QRS on surface ECG. Repeat LV and RV activation map was obtained during His pacing. Average QRS, HV and pacing to V intervals were calculated with standard deviation. Results Mapping was performed successfully in four animals. At baseline, the average QRS duration was 44±2.6ms and HV interval was 32±4.2ms. Earliest site of myocardial activation was in the mid-septal LV region. The earliest RV myocardial activation was also at the septum closer to the apex, but later than the LV (Figure1A). With His pacing, the average QRS duration was 70±17.0ms and the average stim to V interval was 31±8.7ms. During His pacing, the earliest site of activation was in the RV septum, with an activation pattern from base to apex in both the RV and LV. Conclusion Unlike normal physiology, the activation pattern during conduction system pacing is from base to apex with earliest site in the RV. Funding Acknowledgement Type of funding source: Public hospital(s). Main funding source(s): Mayo Clinic

scholarly journals His bundle pacing: a new look at the method

2020 ◽  
Vol 25 ◽  
pp. 4002
Author(s):  
N. A. Prikhodko ◽  
T. A. Lyubimtseva ◽  
S. V. Gureev ◽  
V. K. Lebedeva ◽  
D. S. Lebedev
Keyword(s):  
Biventricular Pacing ◽  
Conduction System ◽  
Cardiac Conduction ◽  
Lead Extraction ◽  
Clinical Anatomy ◽  
His Bundle ◽  
His Bundle Pacing ◽  
Conduction Disorders ◽  
Patients With Heart Failure ◽  
Further Development

His bundle pacing (HBP) implements physiological impulse propagation along the cardiac conduction system and can serve as an analogue of both right ventricular and biventricular pacing. This review highlights clinical anatomy issues related to HBP; the technique of lead implantation in the His position is considered. We also describe the electrophysiological basis of HBP, possibilities of lead extraction, indications for implantation, and prospects for further development of the technique. HBP is a promising direction in cardiology, which in the future may fundamentally change the algorithms for managing patients with heart failure and conduction disorders.

scholarly journals The Emerging Role of Cardiac Conduction System Pacing as a Treatment for Heart Failure

2020 ◽  
Vol 17 (5) ◽  
pp. 288-298
Author(s):  
Nadine Ali ◽  
Mathew Shun Shin ◽  
Zachary Whinnett
Keyword(s):  
Heart Failure ◽  
Cardiac Function ◽  
Left Bundle Branch Block ◽  
Conduction System ◽  
Cardiac Conduction ◽  
Bundle Branch Block ◽  
His Bundle ◽  
His Bundle Pacing ◽  
Patients With Heart Failure ◽  
Ventricular Activation

Abstract Purpose of Review The aim of cardiac resynchronization therapy (CRT) is to improve cardiac function by delivering more physiological cardiac activation to patients with heart failure and conduction abnormalities. Biventricular pacing (BVP) is the most commonly used method for delivering CRT; it has been shown in large randomized controlled trials to significantly improve morbidity and mortality in patients with heart failure. However, BVP delivers only modest reductions in ventricular activation time and is only beneficial in patients with prolonged QRS duration. In this review, we explore conduction system pacing as a method for delivering more effective ventricular resynchronization and to extend pacing therapy for heart failure to patients without left bundle branch block (LBBB). Recent Findings The aim of conduction system pacing is to provide physiological ventricular activation by directly stimulating the conduction system. Current modalities include His bundle and left conduction system pacing. His bundle pacing is the most established method; it has the potential to correct left bundle branch block and deliver more effective ventricular resynchronization than BVP. This translates into greater acute haemodynamic improvements and observational data suggests that His-CRT results in improvements in cardiac function and symptoms. AV-optimized His bundle pacing is being investigated in patients with heart failure and long PR interval without LBBB, to see if this improves exercise capacity. More recently, a technique for pacing the left bundle branch has been developed. Early studies show potential advantages including low and stable capture thresholds. Summary Conduction system pacing can deliver more effective ventricular resynchronization than BVP, which has the potential to deliver greater improvements in cardiac function. It may also provide the opportunity to extend pacing therapy for heart failure to patients who do not have LBBB. Further data is required from randomized trials to assess these promising pacing techniques.

scholarly journals His Bundle Pacing: Rebirth of an Important Technique for Pacing the Intrinsic Conduction System

2018 ◽  
Vol 3 (1) ◽  
pp. 61-71
Author(s):  
Michael R. Kaufmann ◽  
Matthew S. McKillop ◽  
Thomas A. Burkart ◽  
Mark Panna ◽  
William M. Miles ◽  
...  
Keyword(s):  
Conduction System ◽  
His Bundle ◽  
His Bundle Pacing ◽  
Intrinsic Conduction

scholarly journals Upgrade of cardiac resynchronization therapy by utilizing additional His-bundle pacing in a patient with lamine A/C cardiomyopathy: an autopsy case report

2021 ◽  
Author(s):  
Masako Baba ◽  
Kentaro Yoshida ◽  
Osamu Igawa ◽  
Masayoshi Yamamoto ◽  
Akihiko Nogami ◽  
...  
Keyword(s):  
Cardiac Resynchronization Therapy ◽  
Present Report ◽  
Biventricular Pacing ◽  
Scar Tissue ◽  
Left Ventricular ◽  
Conduction System ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy ◽  
His Bundle ◽  
His Bundle Pacing

Abstract Background A number of heart failure patients (HF) do not fully benefit from cardiac resynchronization therapy (CRT). Although His bundle pacing (HBP) have been developed as an alternative strategy, its role for treating advanced cardiomyopathy remains unclear. Case summary We previously reported a patient with lamin A/C cardiomyopathy (Eur Heart J Case Rep. 2020; 4:1-9). He had turned non-response to conventional biventricular pacing (BVP), and an upgrade to CRT combining para-His bundle pacing (HBP) and left ventricular (LV) pacing had markedly improved his HF status. In the present report, we assessed the autopsy and histological findings of this patient. A histological examination of both the LV and right ventricular (RV) apex pacing regions exhibited extensive scarring. Although a distinct conduction system was not identified in the alternative para-HBP region, the RV endocardium had more viable myocytes in this region. Discussion In patients with advanced cardiomyopathy accompanied by extensive fibrosis, RV apex pacing, delivered from scar tissue, can render conventional BVP ineffective. Additionally, HBP alone can not provide adequate resynchronization under the presence of diffuse injury of the His-Purkinje system. In these circumstances, combined para-HB and LV pacing may facilitate electrical and mechanical resynchronization of the ventricles and may be attributed to favourable CRT response in advanced HF, even if para-HBP fails to directly capture the conduction system.

scholarly journals Troubleshooting Programming of Conduction System Pacing

2021 ◽  
Vol 10 (2) ◽  
pp. 85-90
Author(s):  
Elise Bakelants ◽  
Haran Burri
Keyword(s):  
Sinus Rhythm ◽  
Heart Rhythm ◽  
Conduction System ◽  
Atrial Arrhythmia ◽  
Dual Chamber ◽  
Single Chamber ◽  
His Bundle ◽  
His Bundle Pacing ◽  
Device Programming

Conduction system pacing (CSP) comprises His bundle pacing and left bundle branch area pacing and is rapidly gaining widespread adoption. Effective CSP not only depends on successful system implantation but also on proper device programming. Current implantable impulse generators are not specifically designed for CSP. Either single chamber, dual chamber or CRT devices can be used for CSP depending on the underlying heart rhythm (sinus rhythm or permanent atrial arrhythmia) and the aim of pacing. Different programming issues may arise depending on the device configuration. This article aims to provide an update on practical considerations for His bundle and left bundle branch area pacing programming and follow-up.

How many patients treated for bradycardia may be eligible for His bundle pacing?

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
R Chattopadhyay ◽  
P Chousou ◽  
R Thomas ◽  
J O"brien ◽  
F Pierres ◽  
...  
Keyword(s):  
Heart Block ◽  
Sinus Node ◽  
Conduction System ◽  
Ventricular Pacing ◽  
Av Node ◽  
His Bundle ◽  
His Bundle Pacing ◽  
Funding Sources ◽  
System Disease ◽  
Class Iib

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Pacing-Induced Cardiomyopathy (PICM) can lead to significant morbidity, requiring treatment by device upgrade procedures. The risk of occurrence is directly related to the burden of right ventricular pacing, which can be reduced by careful device programming. When frequent ventricular stimulation cannot be avoided, pacing the conduction system may offer an alternative to myocardial pacing and reduce the risk of PICM. The most recent international pacing guidelines recommend that His-bundle pacing should be considered among 1) patients with EF 36-50% and expected to require >40% ventricular pacing (Vp > 40%) (class IIa); and 2) patients requiring pacing who have block at the level of the AV node (class IIb). Purpose This study sought to determine how many patients undergoing bradycardia pacing would have fulfilled those criteria. Methods This was a single-centre retrospective study over a 5 year period to the end of April 2020. Demographic and clinical details of patients receiving device implants were obtained from the Pacing Service Database, along with the indication for pacing, electrocardiographic and echocardiographic data. A cardiology consultant with a special interest in pacing reviewed each case with regards to the likelihood of requiring >40% ventricular pacing. Heart block at the level of the AV node was considered present if patients presented with a narrow QRS in conjunction with second or third degree heart block. Results 1,265 patients underwent pacemaker implant for bradycardia during the study period, 888 for conduction system disease (198 second degree block, 333 complete heart block), 349 for sinus node disease and 28 for other indication. Figure 1 gives a breakdown of patients with conduction system block according to i) level of block; ii) ejection fraction; iii) expectation or not of Vp > 40%.  In total, 166 patients had a class IIa indication for His-bundle pacing. 227 patients had block at the level of the AV node, of whom 36 also fulfilled the class IIa criteria for His-bundle pacing; 191 patients (16% of the total) had a sole class IIb indication for His-bundle pacing. Adjusting for the 176 patients who did not undergo echocardiography, up to an additional 45 patients may be expected to have an indication for His-bundle pacing Conclusion As many as 32% of patients in a bradycardia pacing population may be eligible for His-bundle pacing. This has significant implications for training and service provision. Abstract Figure 1. Flowsheet showing distribution

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