P516Permanent his bundle pacing: conclusions from the one-year experience of a romanian center

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
C G Pestrea ◽  
A Gherghina ◽  
F Ortan
Keyword(s):  
Cardiac Pacing ◽  
Ventricular Pacing ◽  
Pacing Threshold ◽  
Bundle Branch Block ◽  
His Bundle ◽  
His Bundle Pacing ◽  
Increased Risk ◽  
Qrs Duration ◽  
Procedural Success ◽  
One Year

Abstract Background Long term right ventricular pacing has been associated with an increased risk of heart failure development due to pacing induced cardiomyopathy. Therefore, alternatives of more physiological pacing have been evaluated. Amongst them, His bundle pacing (HBP) has emerged in the past two decades as the most physiological method of ventricular pacing due to synchronous activation of both ventricles through the intrinsic conduction system. Although there is an already consistent experience in the United States, China and western Europe regarding His bundle pacing, some countries in central and eastern Europe have little or no experience in this matter. We present the results of our one-year experience after implementing His bundle pacing in a tertiary cardiac pacing center in Romania. Material and methods Between July 2018 and October 2019, HBP using the current available dedicated delivery system was attempted in 50 patients with permanent cardiac pacing indications. Patient characteristics and procedural results were analyzed during implant and at 3 months, 6 months and 1 year follow-ups. Results The mean age of the patients was 70,14 ± 10,58 years and 58 % were male. The main indication for cardiac pacing was atrioventricular block (66%) and 96 % received a dual-chamber pacemaker. No ventricular back-up leads were used. The acute procedural success (selective or nonselective His bundle capture) was achieved in 40 patients (80%). The rest of the patients received either right ventricular or left bundle branch pacing. Selective His bundle pacing was seen in 15 out of 40 patients, with nonselective His bundle pacing in the rest. The acute His pacing threshold was 1.77 ± 1.06 V at 1 ms, the sensed R wave amplitude was 4.2 ± 2.27 mV and total fluoroscopy time was 15.95 ± 10.9 min. The paced QRS duration was very similar to the baseline QRS duration in patients without bundle branch block and significantly narrower in patients with bundle branch block morphology (126,6 ± 23 ms vs. 95,5 ± 21,65 ms,  p < 0,001). The presence of a native QRS complex with a bundle branch block morphology was associated with an increased risk of procedural failure, longer fluoroscopy times and higher capture thresholds. Also, pacing threshold (1,91 ± 1,23 vs. 1,62 ± 0,84 V/1ms , p = 0,4) and fluoroscopy times (21,15 ± 10,35 vs. 10,75 ± 8,85 min, p = 0,002) were lower in the second half of the procedures as the learning curve was achieved.  There were no significant changes in pacing and sensing thresholds at 3 months, 6 months and 1 year follow-ups. There was only one case of lead dislodgement a week after the procedure that required reintervention. Conclusion His bundle pacing is feasible and easy to implement in an experienced device implantation center, with a high procedural success rate. Improvement of the procedural parameters is achieved while advancing the learning curve. Proper patient selection could influence the outcomes of the procedure.

scholarly journals His bundle pacing after failure of cardiac resynchronization therapy: a case study

2020 ◽  
Vol 48 (5) ◽  
pp. 030006052092349
Author(s):  
Katarína Koščová ◽  
Milan Chovanec ◽  
Jan Petrů ◽  
Lucie Šedivá ◽  
Libor Dujka ◽  
...  
Keyword(s):  
Cardiac Resynchronization Therapy ◽  
Cardiac Pacing ◽  
Cardiac Resynchronization ◽  
Ventricular Pacing ◽  
Resynchronization Therapy ◽  
Bundle Branch Block ◽  
Right Ventricular Pacing ◽  
His Bundle ◽  
His Bundle Pacing

His bundle pacing is a relatively new method of cardiac pacing. This method is used in patients with atrioventricular block to prevent heart failure associated with right ventricular pacing, and in patients with bundle branch block and cardiomyopathy. We report a patient with cardiomyopathy and left bundle branch block with failure of cardiac resynchronization therapy. Permanent His bundle pacing was associated with clinical improvement and improvement of parameters of cardiac function.

Abstract 17180: Longitudinal Dissociation in the His Bundle: Persistent Bundle Branch Block Can be Corrected by Permanent His Bundle Pacing

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Pugazhendhi Vijayaraman ◽  
Kenneth A Ellenbogen ◽  
Gopi Dandamudi
Keyword(s):  
Main Body ◽  
Exclusion Criteria ◽  
Pacing Threshold ◽  
Bundle Branch Block ◽  
His Bundle ◽  
His Bundle Pacing ◽  
Number Of Patients ◽  
Pacing Lead ◽  
Qrs Duration ◽  
Longitudinal Dissociation

Introduction: Focal disease in the main body of the His bundle (HB) is the cause for majority of the bundle branch block (BBB) patterns on EKG. Temporary distal HB pacing (HBP) has previously been shown to correct BBB in high number of patients. Anecdotal reports have confirmed abolition of BBB by permanent HBP. Hypothesis: The aim of our study is to report the incidence of correction of BBB during permanent HBP in patients undergoing pacemaker (PM) implantation. Methods: Permanent HBP was attempted in 185 patients referred for PM implantation. Pts with QRS duration (d) ≥110 ms and BBB were included in the study. Pts with normal QRS or CHB were excluded. HBP was performed using the Medtronic SelectSecure 3830 pacing lead. Baseline QRSd, paced QRSd, correction of BBB and HB pacing threshold were recorded. Results: Fifty patients met the inclusion-exclusion criteria. Mean age 73±12 yrs; men 65%, HTN 81%, DM 30%, CAD 38%, AF 42%, SSS 39%, AV disease 61%, RBBB 31, LBBB 14, IVCD 5). Permanent HBP was successful in correcting BBB in 42 (84%) patients. Underlying BBB was corrected by HBP in 29 of 31 (94%) patients with RBBB; 11 of 14 (79%) patients with LBBB; 1 of 5 (20%) patients with IVCD. Baseline QRSd improved from 141±15 ms to 124±17 ms. HBP threshold at implant was 1.5±1.3 V @ 0.5 ms. Conclusions: Permanent HBP corrected underlying BBB in the vast majority of patients with right or left BBB (40 of 45, 89%) compared to only 1 of 5 (20%) patients with IVCD. This confirms that focal disease in the main HB is the cause for BBB in the patients referred for PM implantation.

scholarly journals Learning Curve for Left Bundle Branch Area Pacing – the Experience of a Romanian Academic Center

2021 ◽  
Vol 31 (2) ◽  
pp. 327-334
Author(s):  
Catalin PESTREA ◽  
Alexandra GHERGHINA ◽  
Irina PINTILIE ◽  
Florin ORTAN
Keyword(s):  
Cardiac Resynchronization Therapy ◽  
Learning Curve ◽  
Cardiac Pacing ◽  
Cardiac Resynchronization ◽  
Qrs Complex ◽  
Resynchronization Therapy ◽  
Pacing Threshold ◽  
Bundle Branch Block ◽  
His Bundle ◽  
His Bundle Pacing

Introduction: There is an increasing interest in the past decade for more physiological pacing strategies due to detrimental long-term right ventricular pacing. His bundle pacing is the most physiological one, but it has some drawbacks, mainly an increased pacing threshold. Left bundle branch area pacing (LBBAP) emerged in the recent years as the next step in conduction system pacing. We present our initial experience and learning curve with this latter procedure. Material and methods: During January 2019 and February 2021, 20 patients with pacing indications that failed initial permanent His bundle pacing underwent successful LBBAP. Results: The mean age was 65.9 ± 12.7 years. The indications for cardiac pacing were AV block in 14 patients(70%) and cardiac resynchronization therapy in 6 patients (30%). At baseline, normal QRS complex was noted in 9 patients, a left bundle branch block pattern in 10 patients and a right bundle branch block in one patient. A total of 18 dual-chamber and one single chamber pacemakers were implanted and a cardiac resynchronization therapy defibrillator (CRT-D) device. The acute pacing threshold was 0.56±0.2 V at 0.4ms, the sensing threshold was 10.3±3.9 mV and the impedance was 684.9±112.2 Ω. The overall QRS duration decreased after LBBAP from 128.5 ± 27ms to 103.6 ± 17.4ms (p= 0.001). In patients with baseline wide QRS complex there was a highly significant decrease from 148.2 ± 11.6 ms to 104.7 ± 19.4 ms (p<0.001). The fl uoroscopy time, including the time spent for His bundle location, was 13.8 ± 8.5 minutes. The pacing thresholds remained constant after three-months (0.6 ± 0.2 V vs. 0.56 ± 0.2 V at 0.4 ms). We had two intraprocedural septal perforations without any consequences and three micro dislodgements at follow-up with pure left septal capture. Conclusion: Left bundle branch area pacing is a feasible physiological pacing technique with a high success rate and the potential to overcome the limits of permanent His bundle pacing. It can be successfully performed virtually in all types of pacing indications, including cardiac resynchronization therapy as provides a rapid and synchronous activation of the left ventricle.

scholarly journals 204 Permanent his bundle pacing using stylet-driven lead in patients with right atriomegaly: a single-centre experience

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Leonardo Marinaccio ◽  
Francesco Vetta ◽  
Eros Rocchetto ◽  
Paola Napoli ◽  
Domenico Marchese
Keyword(s):  
The Novel ◽  
Success Rates ◽  
Pacing Threshold ◽  
Lead System ◽  
His Bundle ◽  
His Bundle Pacing ◽  
First Choice ◽  
Single Centre Experience ◽  
Qrs Duration ◽  
Procedural Success

Abstract Aims His bundle pacing (HBP) is becoming an increasing widespread approach for physiological pacing. However, successful HBP procedure could be hampered by limited implantation tools especially in challenging anatomies. We aimed to report our experience with HBP technique using a novel stylet-driven lead system in patients with right atriomegaly. Methods and results Consecutive patients with right atrium (RA) volume &gt;25 ml/m2 in men and &gt;21 ml/m2 in women who underwent permanent HBP for standard indications were enrolled from March 2020 to March 2021. The tool of first choice for HBP attempt was a stylet-driven lead (Solia S 60, Biotronik) delivered via a dedicated introducer sheath (Selectra 3D, Biotronik). The acute, 1-month and 6-month procedural success rates were assessed. We enrolled 24 patients [median age: 75 (70–79) years, 85% men] with an average RA volume of 50.7 ± 7.8 ml/m2. At implant, conduction system pacing using stylet-driven lead was achieved in 21 patients (87%): 12 (50%) selective HBP, 6 (25%) non-selective HBP, and 3 (12.5%) left bundle branch area pacing. In the three failures, HBP was further attempted with a lumen-less lead with fixed helix (SelectSecure 3830, Medtronic) with final procedural success in two cases. In the successful cases, there was a significant reduction of QRS duration between paced and spontaneous beats [152.5 (130–167.5) ms vs. 130 (122.5–137.5) ms, P = 0.003]. No lead dislodgment nor significant pacing threshold increase was observed at 1-month (1.30 ± 0.76 [email protected] vs. 1.32 ± 0.80 [email protected] ms, P &gt; 0.9) and 6-month follow-up (1.30 ± 0.76 [email protected] vs. 1.38 ± 0.97 [email protected] ms, P = 0.66). Conclusions In patients with right atriomegaly, the novel stylet-driven lead system showed high implant success rates with stable pacing thresholds.

scholarly journals Alternative sites of ventricular pacing: His bundle pacing

2020 ◽  
Vol 90 (2) ◽  
Author(s):  
Francesco Vetta ◽  
Leonardo Marinaccio ◽  
Giampaolo Vetta
Keyword(s):  
Heart Failure ◽  
Biventricular Pacing ◽  
Scientific Evidence ◽  
Cardiac Pacing ◽  
Cardiac Conduction ◽  
Cardiac Resynchronization ◽  
Conduction Delay ◽  
Ventricular Pacing ◽  
His Bundle ◽  
His Bundle Pacing

Since its introduction right ventricular apical (RVA) pacing has been the mainstay in cardiac pacing. However, in recent years there has been an upsurge of interest in permanent His bundle pacing (HBP), given the scientific evidence of the harmful role of dyssynchronous ventricular activation, induced by RVA pacing, in promoting the onset of heart failure and atrial fibrillation. After an intermediate period in which attention was focused on algorithms aimed at minimizing ventricular pacing, with partially inadequate and harmful results, scientific attention shifted to HBP, which proved to ensure a physiological electro-mechanical activation of the ventricles. The encouraging results obtained have allowed the introduction of HBP in recent guidelines for cardiac pacing in patients with bradicardia and cardiac conduction delay. Recent studies have also demonstrated the potential of HBP in patients with left bundle branch block and heart failure. HBP is promising as an attractive way to achieve physiological stimulation in patients with an indication for cardiac resynchronization therapy (CRT). Comparative studies of HB-CRT and biventricular pacing have shown similar results in numerically modest cohorts, although HB-CRT has been shown to promote better ventricular electrical resynchronization as demonstrated by a greater QRS narrowing. A widespread use of this pacing tecnique also depends on improvements in technology, as well as further validation of effectiveness in large randomised clinical trials

6119Correction of transcatheter aortic valve replacement induced left bundle branch block by His bundle pacing

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
J De Pooter ◽  
S Calle ◽  
M Coeman ◽  
T Philipsen ◽  
P Gheeraert ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Left Bundle Branch Block ◽  
Transcatheter Aortic Valve Replacement ◽  
Permanent Pacemaker ◽  
Bundle Branch Block ◽  
His Bundle ◽  
His Bundle Pacing ◽  
Transcatheter Aortic Valve ◽  
Qrs Duration

Abstract Background Left bundle branch block (LBBB) occurs frequently after transcatheter aortic valve replacement (TAVR) and is associated with increased risk of permanent pacemaker implantation, heart failure hospitalization and sudden cardiac death. This pilot study explored the feasibility of TAVR-induced LBBB correction with His bundle pacing (HBP). Methods Patients with TAVR -induced LBBB and postoperative need for permanent pacemaker implant were planned for electrophysiology study and HBP. Patients with persistent high degree AV-block were excluded. HBP was performed using the Select Secure pacing lead, delivered through a fixed curve or a deflectable sheath. Successful HBP was defined as correction of LBBB by selective or non-selective HBP with LBBB correction thresholds less than 3.5V at 1.0ms at implant. Results The study enrolled 6 patients (mean age 85±2.5 years, 50% male). Mean QRS duration was 152±10ms, PR-interval 212±12ms AH-interval 166±16ms and HV-interval 62±12ms. Successful HBP was achieved in 5/6 (83%) patients. Mean QRS duration decreased from 153±11ms to 88±14ms (p=0.002). At implantation, mean threshold for LBBB correction was 1.6±1.0V (unipolar) and 2.2±1.3V (bipolar) at 1.0ms. Periprocedural, two complete AV-blocks occurred, both spontaneously resolved by the end of the procedure. Thresholds remained stable at 1 month follow up: 1.8±1.0V (unipolar) and 2.3±1.5V (bipolar) at 1.0ms. Figure 1 Conclusion Permanent His bundle pacing can safely correct TAVR-induced LBBB in the majority of patients. Further studies are needed to assess potential benefits of His bundle pacing over conventional right ventricular pacing in this population.

scholarly journals Left bundle branch pacing: the new kid on the block

2021 ◽  
Vol 30 (4) ◽  
pp. 571-575
Author(s):  
Andra Gurgu ◽  
Dragos Cozma ◽  
Mihail G. Chelu
Keyword(s):  
Heart Failure ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Current Status ◽  
Ventricular Pacing ◽  
Right Ventricular Pacing ◽  
His Bundle ◽  
His Bundle Pacing ◽  
Physiologic Form ◽  
Increased Risk

Right ventricular pacing is has deletorius effects due to left ventricular dysynchrony and remodelling and may result in heart failure. Over the last decade, His bundle pacing has emerged as the most physiologic form pacing. However, it has limitations, such as higher capture thresholds, lower R wave amplitudes, atrial oversensing, and increased risk for lead revisions from late threshold increase with subsequent premature battery depletion, which has prevented a wider adoption of this technique in routine clinical practice. Left bundle branch pacing has been developed as an alternative physiologic pacing strategy that overcomes most of His bundle pacing limitations. This article summarizes the current status of left bundle branch pacing. Keywords: His bundle pacing, left bundle branch pacing, cardiac resynchronization, therapy heart failure.

scholarly journals A network meta-analysis and systematic review of change in QRS duration after left bundle branch pacing, His bundle pacing, biventricular pacing, or right ventricular pacing in patients requiring permanent pacemaker

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Nithi Tokavanich ◽  
Narut Prasitlumkum ◽  
Wimwipa Mongkonsritragoon ◽  
Wisit Cheungpasitporn ◽  
Charat Thongprayoon ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Biventricular Pacing ◽  
Meta Analysis ◽  
Mean Difference ◽  
Ventricular Pacing ◽  
Right Ventricular Pacing ◽  
His Bundle ◽  
His Bundle Pacing ◽  
Significant Difference ◽  
Qrs Duration

AbstractCardiac dyssynchrony is the proposed mechanism for pacemaker-induced cardiomyopathy, which can be prevented by biventricular pacing. Left bundle branch pacing and His bundle pacing are novel interventions that imitate the natural conduction of the heart with, theoretically, less interventricular dyssynchrony. One of the surrogate markers of interventricular synchrony is QRS duration. Our study aimed to compare the change of QRS duration before and after implantation between types of cardiac implantable electronic devices (CIEDs): left bundle branch pacing versus His bundle pacing versus biventricular pacing and conventional right ventricular pacing. A literature search for studies that reported an interval change of QRS duration after CIED implantation was conducted utilizing the MEDLINE, EMBASE, and Cochrane databases. All relevant works from database inception through November 2020 were included in this analysis. A random-effects model, Bayesian network meta-analysis was used to analyze QRS duration changes (eg, electrical cardiac synchronization) across different CIED implantations. The mean study sample size, from 14 included studies, was 185 subjects. The search found 707 articles. After exclusions, 14 articles remained with 2,054 patients. The His bundle pacing intervention resulted in the most dramatic decline in QRS duration (mean difference, − 53 ms; 95% CI − 67, − 39), followed by left bundle branch pacing (mean difference, − 46 ms; 95% CI − 60, − 33), and biventricular pacing (mean difference, − 19 ms; 95% CI − 37, − 1.8), when compared to conventional right ventricle apical pacing. When compared between LBBP and HBP, showed no statistically significant wider QRS duration in LBBP with mean different 6.5 ms. (95% CI − 6.7, 21). Our network meta-analysis found that physiologic pacing has the greatest effect on QRS duration after implantation. Thus, HBP and LBBP showed no significant difference between QRS duration after implantation. Physiologic pacing interventions result in improved electrocardiography markers of cardiac synchrony, narrower QRS duration, and might lower electromechanical dyssynchrony.

scholarly journals How to Implant His Bundle and Left Bundle Pacing Leads: Tips and Pearls

2021 ◽  
Vol 7 ◽  
Author(s):  
Shunmuga Sundaram Ponnusamy ◽  
Pugazhendhi Vijayaraman
Keyword(s):  
Cardiac Pacing ◽  
Cardiac Resynchronisation Therapy ◽  
His Bundle ◽  
His Bundle Pacing ◽  
Increased Risk ◽  
Cardiac Resynchronisation ◽  
Significant Efficacy ◽  
Resynchronisation Therapy ◽  
Right Ventricular Apical Pacing ◽  
Tools And Techniques

Cardiac pacing is the treatment of choice for the management of patients with bradycardia. Although right ventricular apical pacing is the standard therapy, it is associated with an increased risk of pacing-induced cardiomyopathy and heart failure. Physiological pacing using His bundle pacing and left bundle branch pacing has recently evolved as the preferred alternative pacing option. Both His bundle pacing and left bundle branch pacing have also demonstrated significant efficacy in correcting left bundle branch block and achieving cardiac resynchronisation therapy. In this article, we review the implantation tools and techniques to perform conduction system pacing.

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