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.

scholarly journals Programmed deep septal pacing for the diagnosis of left bundle branch capture

2019 ◽  
Author(s):  
Marek Jastrzębski ◽  
Paweł Moskal ◽  
Aleksander Kusiak ◽  
Agnieszka Bednarek ◽  
Tomasz Sondej ◽  
...  
Keyword(s):  
Refractory Period ◽  
Pacemaker Implantation ◽  
Drive Train ◽  
Effective Refractory Period ◽  
Qrs Complex ◽  
Septal Pacing ◽  
Pacing Lead ◽  
Qrs Morphology ◽  
Premature Beats ◽  
Septal Myocardium

AbstractBackgroundDuring permanent deep septal pacing, it is important to confirm left bundle branch (LBB) capture.ObjectiveThe effective refractory period (ERP) of the working myocardium is different than the ERP of the LBB; we hypothesized that it should be possible to differentiate LBB capture from septal myocardial capture using programmed extra-stimulus technique.MethodsIn consecutive patients undergoing pacemaker implantation who received pacing lead in a deep septal position programmed pacing was delivered from this lead. Responses to programmed pacing were categorized on the basis of QRS morphology of the extrastimuli as: myocardial (broader QRS, often slurred), selective (narrower QRS, preceded by an isoelectric interval) or non-diagnostic (unequivocal change).ResultsProgrammed deep septal pacing was performed 269 times in 143 patients; in every patient with the use of an 8-beat basic drive train of 600 ms and when possible also during supraventricular rhythm. Responses diagnostic for LBB capture were observed in 114 (79.7%) of patients. Selective LBB paced QRS was more often seen when premature beats were introduced during the intrinsic rhythm rather than after the basic drive train. The average septal-myocardial refractory period was significantly shorter than the LBB refractory period: 263.0±34.4 ms vs. 318.0±37.4 ms.ConclusionsA novel maneuver for the diagnosis of LBB capture during deep septal pacing, was formulated, assessed and found as diagnostically valuable. This method, based on the differences in refractoriness between LBB and the septal myocardium is unique in enabling the visualization of components of the usually fused, non-selective LBB paced QRS complex.Graphical abstract

P6018Can chronic his bundle pacing be safely started in centers with lack of experience of this technique? Data from a multicentric registry

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
C Chaumont ◽  
E Popescu ◽  
N Auquier ◽  
A Milhem ◽  
G Viart ◽  
...  
Keyword(s):  
Sinus Node ◽  
Pacemaker Implantation ◽  
Bundle Branch Block ◽  
His Bundle ◽  
His Bundle Pacing ◽  
Ventricular Lead ◽  
Device Infection ◽  
The Mean ◽  
Tool Set

Abstract Introduction Right ventricular pacing (RVP) induces ventricular asynchrony in patients with normal QRS and increases the risk of heart failure and atrial fibrillation on long term. His bundle pacing (HBP) is a physiological alternative to RVP. Interest in HBP has been hampered in part by technical challenges and limited implantation tool set. Recent studies assessed feasibility and safety in expert centers with a vast experience of HBP. These results may not apply to less experienced centers. Purpose To evaluate feasibility and safety of permanent his bundle pacing in hospitals with limited technical training to this technique and to evaluate stability of his bundle capture thresholds at 3 months follow up. Methods We included all patients who underwent pacemaker implantation with attempt of HBP in three hospitals between September 2017 and December 2018. All the 5 operators were novice for HBP at the beginning of the study. Selective his bundle capture (HBC) was defined as concordance of QRS and T waves complexes with the native ECG (patients with underlying bundle branch block may normalize), presence of a delay between spike and QRS complex, absence of widening of the QRS at a low pacing output, and recordable his bundle electrogram. At 3 months follow-up, his bundle capture thresholds, R-wave amplitudes and pacing impedances were recorded. Results HPB was successful in 51 of 58 patients (87.9%); selective HBC was obtained in 40 patients while nonselective HBC occurred in 11 patients. Indication for pacemaker implantation was atrioventricular conduction disease in 31 patients (53%), sinus node dysfunction in 5 patients (9%) and AV nodal ablation for non-controlled atrial arrhythmias in 22 patients (38%). AV nodal ablation was performed during the same procedure in 14 patients. The mean procedure duration was 75±8 min, and mean fluoroscopy duration was 10±2 min. The mean HBP threshold was 1.47±0.27 V and did not increase after a 3 months follow-up (1.12±0.18 V). Only 7 patients (14%) had HBP threshold >2V/0.5ms. The mean impedance was 477±37 Ω and slightly decreased at 3 months (364±24Ω). The mean R-wave amplitude was 4.1±1 mV at implantation and 3.2±0.6 mV at 3 months. Bundle branch block correction was achieved in 5 of 7 patients with underlying left bundle branch block. There was no pericardial effusion, no pneumothorax and no device infection. Ventricular lead revision was required at 3 months in one patient for sudden threshold increase, without obvious dislodgement. LBBB correction after HBP Conclusion His bundle pacing performed by novice operators to this technique appeared feasible and safe. The mean HBP threshold did not increase at 3 months follow-up.

scholarly journals Permanent His-Bundle Pacing in the Right Atrium in a Patient With a Mobitz II Atrioventricular Block: A Case Presentation

2021 ◽  
Author(s):  
Zaiqiang Zhang ◽  
Jiawang Ding
Keyword(s):  
Sick Sinus Syndrome ◽  
Pacemaker Implantation ◽  
Promising Alternative ◽  
Case Presentation ◽  
Right Ventricular Pacing ◽  
His Bundle ◽  
His Bundle Pacing ◽  
History Of ◽  
Optimal Approach ◽  
The Right

Abstract Background: This case report presents a patient diagnosed with sick sinus syndrome who was successfully treated with permanent His-bundle pacing (PHBP).Case presentation: A 36-year-old man was transferred to our hospital due to recurrent syncope. He was diagnosed with sick sinus syndrome based on the 24-hour Holter and a history of syncope. He was admitted to hospital and successfully treated with PHBP. The postoperative examination showed that the pacing rhythm, pacemaker pacing and perception function were normal. He was discharged without any complications after a successful pacemaker implantation. Conclusions: We described a case in which PHBP may become an optimal approach to the management of patients with sick sinus syndrome. Right ventricular pacing has been attempted with inconsistent efficacy outcomes. HBP provides a promising alternative pacing option that might provide symptom resolution to patients with sick sinus syndrome.

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 Electrocardiographic characterization of non-selective His bundle pacing. Validation of novel diagnostic criteria

2019 ◽  
Author(s):  
Marek Jastrzębski ◽  
Paweł Moskal ◽  
Karol Curila ◽  
Kamil Fijorek ◽  
Piotr Kukla ◽  
...  
Keyword(s):  
Sensitivity And Specificity ◽  
Left Ventricular ◽  
Peak Time ◽  
List Type ◽  
Intraventricular Conduction ◽  
His Bundle ◽  
His Bundle Pacing ◽  
Conduction Disturbances ◽  
Surface Ecg ◽  
Ecg Criteria

AbstractAimsPermanent His bundle (HB) pacing is usually accompanied by simultaneous capture of the adjacent right ventricular (RV) myocardium - this is described as a non-selective (ns)-HB pacing. Our aim was to identify ECG criteria for loss of HB capture during ns-HB pacing.MethodsConsecutive patients with permanent HB pacing were recruited. Surface 12-lead ECGs during ns-HB pacing and loss of HB capture (RV-only capture) were obtained. ECG criteria for loss/presence of HB capture were identified. In the validation phase these criteria and the “HB ECG algorithm” were tested by two blinded observers using a separate, sizable set of ECGs.ResultsA total of 353 ECG (226 ns-HB and 128 RV-only) were obtained from 226 patients with permanent HB pacing devices. QRS notch/slur in left ventricular leads and R-wave peak time in lead V6 were identified as the best features for differentiation. The 2-step HB ECG algorithm based on these features correctly classified 87.1% of cases with sensitivity and specificity of 93.2% and 83.9%, respectively. Moreover, the proposed criteria for definitive diagnosis of ns-HB capture (no QRS slur/notch in leads I, V1, V4-V6 and the R-wave peak time in V6 ≤ 100 ms) presented 100% specificity.ConclusionA novel ECG algorithm for the diagnosis of loss of HB capture and novel criteria for definitive confirmation of HB capture were formulated and validated. Practical application of these criteria during implant and follow-up of patients with HB pacing devices is feasible.Condensed AbstractThe 2-step ECG algorithm for loss of His bundle capture based on surface ECG analysis is proposed and validated. This method correctly classified 87.1% of cases with a sensitivity and specificity of 93.2% and 83.9%, respectively.What’s NewThis is the first study that analyzes QRS characteristics during non-selective His bundle pacing in a sizable cohort of patients.Precise criteria and a novel algorithm for electrocardiographic diagnosis of loss of HB capture during presumed non-selective HB pacing were validated.QRS notch/slur in left ventricular leads was identified as a simple and reproducible feature indicating loss of HB capture or lack/loss of correction of intraventricular conduction disturbances.Assessment of R-wave peak time in lead V6 rather than QRS duration for diagnosis of ns-HB pacing was validated.

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 Permanent His-bundle pacing in the right atrium in a patient with a Mobitz II atrioventricular block: a case presentation

2022 ◽  
Vol 17 (1) ◽  
Author(s):  
Zai-Qiang Zhang ◽  
Jia-Wang Ding
Keyword(s):  
Sick Sinus Syndrome ◽  
Pacemaker Implantation ◽  
Promising Alternative ◽  
Case Presentation ◽  
Right Ventricular Pacing ◽  
His Bundle ◽  
His Bundle Pacing ◽  
History Of ◽  
Optimal Approach ◽  
The Right

Abstract Background This case report presents a patient diagnosed with sick sinus syndrome who was successfully treated with permanent His-bundle pacing (PHBP). Case presentation A 36-year-old man was transferred to our hospital due to recurrent syncope. He was diagnosed with sick sinus syndrome based on the 24-h Holter and a history of syncope. He was admitted to hospital and successfully treated with PHBP. The postoperative examination showed that the pacing rhythm, pacemaker pacing and perception function were normal. He was discharged without any complications after a successful pacemaker implantation. Conclusions We described a case in which PHBP may become an optimal approach to the management of patients with sick sinus syndrome. Right ventricular pacing has been attempted with inconsistent efficacy outcomes. HBP provides a promising alternative pacing option that might provide symptom resolution to patients with sick sinus syndrome.

scholarly journals Novel Wide-Band Dielectric Imaging System Guided Lead Deployment for His Bundle Pacing: A Feasibility Study

2021 ◽  
Vol 8 ◽  
Author(s):  
Wei Hua ◽  
Xi Liu ◽  
Min Gu ◽  
Hong-xia Niu ◽  
Xuhua Chen ◽  
...  
Keyword(s):  
Imaging System ◽  
Pacemaker Implantation ◽  
Wide Band ◽  
Standard Group ◽  
His Bundle ◽  
His Bundle Pacing ◽  
Mapping System ◽  
Fluoroscopic Time ◽  
Procedural Time ◽  
Qrs Duration

Introduction: His bundle pacing (HBP) is the most widely used physiological pacing modality, but difficulties in locating the His bundle lead to high fluoroscopic exposure. An electroanatomical mapping (EAM) system can be an efficient tool to achieve HBP implantation with near-zero fluoroscopic visualization.Methods: In the study, 20 patients who had indications for pacemaker implantation were prospectively enrolled and underwent HBP implantation either with the conventional fluoroscopy approach (the standard group) or guided by a novel KODEX-EPD mapping system (the EAM-guided group). The success rate, procedural details, pacing parameters, and procedure-related complications were compared between the two groups.Results: In the study, 20 consecutive patients were randomized with 10 patients in each group. HBP was successfully achieved in nine patients in the standard group and nine patients in the EAM-guided group. The procedural time was similar between the EAM-guided group vs. the standard group (85.40 ± 22.34 vs. 86.50 ± 15.05 min, p = 0.90). In comparison with the standard group, the EAM-guided group had a significant shorter total fluoroscopic time (FT) (1.45 ± 0.58 vs. 12.36 ± 5.46 min, p &lt; 0.01) and His lead fluoroscopic time (HL-FT) (0.84 ± 0.56 vs. 9.27 ± 5.44 min, p &lt; 0.01), while lower total fluoroscopic dose (3.13 ± 1.24 vs. 25.38 ± 11.15 mGy, p &lt; 0.01) and His lead fluoroscopic dose (1.85 ± 1.17 vs. 19.06 ± 11.03 mGy, p &lt; 0.01). No significant differences were observed in paced QRS duration and pacing parameters between the two groups. During a 3-month follow-up, one patient had a capture threshold increased &gt;1 V/1.0 ms in the standard group, while no other complications were recorded in either group.Conclusion: The KODEX-EPD system could facilitate HBP implantation with significantly reduced FT and dose without compromising the procedural time.

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