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.

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

P1239His-bundle pacing in CHF-patients with narrow QRS and chronic AF using dual-chamber ICD

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A Slawuta ◽  
K Boczar ◽  
A Zabek ◽  
A Ciesielski ◽  
J Hiczkiewicz ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Congestive Heart Failure ◽  
Dual Chamber ◽  
His Bundle ◽  
His Bundle Pacing ◽  
Narrow Qrs ◽  
Group A ◽  
Group B

Abstract The heart rate regularization is crucial for proper treatment of patients with atrial fibrillation and congestive heart failure. The standard resynchronization can be applied, but in patients with narrow QRS this procedure is of no use. The aim of our study is to assess the efficacy of direct His-bundle pacing in patients with congestive heart failure and chronic atrial fibrillation using dual chamber ICD implanted for prevention of sudden cardiac death. Methods The study population included 78 patients with CHF and chronic AF: group A - 56 pts treated with direct His-bundle pacing using atrial port of dual chamber ICD and group B - 22 patients implanted with single chamber ICD as recommended by the guidelines. The patients in group B constituting clinical controls were derived from the Heart Failure Outpatients Clinic with established clinical status and pharmacotherapy. Results The demographic data, clinical characteristics and echocardiography measurements at baseline and during follow-up were presented in the table: Table 1 Group A Group B P value Age (years) 69.7±6.9 66.7±11.3 n.s. Sex (% of male sex) 84.0 86.4 n.s. Ventricular pacing (%) – 46.3±31.2 – His-bundle pacing (%) 81.7±9.2 – – pre post pre post pre vs. post LVEDD (mm) 66.9±4.9 59.9±4.7 64.8±8.0 64.7±8.1 <0.01 n.s. EF (%) 29.6±3.8 43.6±5.9 28.1±6.1 28.8±7.3 <0.01 n.s. NYHA class 2.7±0.6 1.4±0.6 2.5±0.6 2.0±0.2 <0.05 n.s. B-blocker dose (metoprolol equivalent dose) 104.6±41.6 214.3±82.6 78.3±56.6 103.1±49.2 <0.001 <0.05 During 12-months of follow-up the mean values of NYHA functional class, EF and LV dimensions did not change in group B but significantly improved in group A. The physiological His-bundle based pacing enabled optimal beta-blocker dosing. The studied groups had no tachyarrhythmia at baseline so the presumable atrial fibrillation-related harm depends on the rhythm irregularity. 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 CHF-patients with narrow QRS and chronic AF benefit from substantially higher beta-blockade which can be instituted in His-bundle pacing group.

scholarly journals Can atrioventricular node ablation be safely performed in patients with permanent His bundle pacing? Data from a multicentric registry

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
C Chaumont ◽  
N Auquier ◽  
A Mirolo ◽  
E Popescu ◽  
A Milhem ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Rate Control ◽  
Atrioventricular Node ◽  
Atrial Arrhythmia ◽  
Av Node ◽  
His Bundle ◽  
His Bundle Pacing ◽  
Ventricular Lead ◽  
Qrs Duration

Abstract Introduction Ventricular rate control is essential in the management of atrial fibrillation. Atrioventricular node ablation (AVNA) and ventricular pacing can be an effective option when pharmacological rate control is insufficient. However, right ventricular pacing (RVP) induces ventricular desynchronization in patients with normal QRS and increases the risk of heart failure on long term. His bundle pacing (HBP) is a physiological alternative to RVP. Observational studies have demonstrated the feasibility of HBP but there is still very limited data about the feasibility of AVNA after HBP. Purpose To evaluate feasibility and safety of HBP followed by AVNA in patients with non-controlled atrial arrhythmia. Methods We included in three hospitals between september 2017 and december 2019 all patients who underwent AVNA for non-controlled atrial arrhythmia after permanent His bundle pacing. No back-up right ventricular lead was implanted. AVNA procedures were performed with 8 mm-tip ablation catheter. Acute HBP threshold increase during AVNA was defined as a threshold elevation &gt;1V. His bundle capture (HBC) thresholds were recorded at 3 months follow-up. Results AVNA after HBP lead implantation was performed in 45 patients. HBP and AVNA were performed simultaneously during the same procedure in 10. AVNA was successful in 32 of 45 patients (71%). Modulation of the AV node conduction was obtained in 7 patients (16%). The mean procedure duration was 42±24min, and mean fluoroscopy duration was 6.4±8min. A mean number of 7.7±9.9 RF applications (347±483 sec) were delivered to obtain complete / incomplete AV block. Acute HBC threshold increase occurred in 8 patients (18%) with return to baseline value at day 1 in 5 patients. There was no lead dislodgment during the AVNA procedures. Mean HBC threshold at implant was 1.26±[email protected] and slightly increased at 3 months follow-up (1.34±[email protected]). AV node re-conduction was observed in 5 patients (16% of the successful procedures) with a second successful ablation procedure in 4 patients. No ventricular lead revision was required during the follow-up period. The baseline native QRS duration was 102±21 ms and the paced QRS duration was 107±18 ms. Conclusion AVNA combined with HBP for non-controlled atrial arrhythmia is feasible and does not compromise HBC but seems technically difficult with significant AV nodal re-conduction rate. The presence of a back-up right ventricular lead could have changed our results and therefore would require further evaluation. Unipolar HBP after AV node ablation Funding Acknowledgement Type of funding source: None

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 &lt;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

Abstract 17261: Maintenance of Sinus Rhythm After His Bundle Pacing and AV Nodal Ablation in Patients With Recurrent Atrial Fibrillation After Catheter Ablation

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Amrish Deshmukh ◽  
Puspha Khanal ◽  
Amlish Gondal ◽  
Mary Romanyshyn ◽  
Pramod Deshmukh
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Sinus Rhythm ◽  
Cardiac Resynchronization ◽  
Atrial Remodeling ◽  
Clinical Recurrence ◽  
His Bundle ◽  
His Bundle Pacing ◽  
Recurrent Atrial Fibrillation

Background: Catheter ablation (CA) is the most effective means of rhythm control for atrial fibrillation (AF) but is not curative. Irregular and rapid ventricular activation by AF begets AF. Cardiac resynchronization and atrioventricular nodal (AVN) ablation have been associated with favorable atrial remodeling and spontaneous reversion to sinus rhythm in patients with longstanding atrial fibrillation. Hypothesis: We hypothesized that in patients with longstanding persistent AF who had failed CA, AVN ablation and His bundle pacing (HBP) may improve maintenance of sinus rhythm. Methods and Results: A total of 13 patients (5 female, age 69±8.7 years, 8 with HFrEF, BMI 29 ±5 kg/m 2 ,LVEF 38±15%, NYHA 3±0.6) underwent simultaneous AVN ablation and HBP an average of 531 days (Range 1-2158 days) after CA for AF with recurrent AF. Prior to AVN ablation and HBP these patients had a median 9-year history of AF (IQR: 5-15 years) with a median of 2 prior cardioversions (IQR: 1-4) and 2 prior CA. All patients had failed at least 1 antiarrhythmic drug. In 3 patients HBP induced cardiac resynchronization of pre-existing bundle branch block and in 8 patients HBP was fused with ventricular pacing to optimize QRS duration. 12 of 13 patients had an atrial lead. All patients underwent cardioversion at the time of the procedure. In a median of follow up of 21 months (IQR:4-74 months), 7 of the 13 patients (54%) had no device detected or clinical recurrence of AF. In follow up LVEF increased to 46±12.7% and NYHA class to 2 ±0.2. Of patients with recurrence, 3 underwent CA and had no recurrence of AF in subsequent follow up. Conclusion: In patients with advanced longstanding persistent AF, a strategy of AVN ablation and HBP allowed for ventricular rate control with a narrow QRS. This approach resulted in a lower than expected rate of AF recurrence.

P5426His-bundle pacing in CHF-patients with narrow QRS and chronic AF using dual-chamber ICD - an upgrade from single-chamber to dual-chamber ICD

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A Ciesielski ◽  
A Slawuta ◽  
K Boczar ◽  
A Zabek ◽  
B Malecka ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Nyha Class ◽  
Clinical Status ◽  
Chronic Atrial Fibrillation ◽  
P Value ◽  
Dual Chamber ◽  
Icd Implantation ◽  
Single Chamber ◽  
His Bundle

Abstract A single-chamber ICD is a standard method for primary SCD prophylaxis. In patients with chronic atrial fibrillation it dose not contribute to the regularization of heart rate, which is crucial for proper treatment. The aim of our study was to assess the efficacy of direct His-bundle pacing in patients with congestive heart failure and chronic atrial fibrillation using upgrade from single chamber to dual-chamber ICD. Methods The study population included 21 patients with CHF and chronic AF implanted primarily with single chamber ICD with etablished pharmacotherapy and stable clinical status. Results The echocardiography measurements at baseline and during ollow-up were presented in the table: Table 1 Baseline Follow-up p-value LVEDD (ms) 67.7±10.7 64.5±8.6 <0.05 EF (%) 27.0±4.8 33.2±6.9 <0.05 NYHA class 2.8±0.6 1.9±0,5 <0.05 During short 4-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.

scholarly journals Long-term follow-up of thoracoscopic ablation for long-standing persistent atrial fibrillation

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
N Harlaar ◽  
M.A.P Oudeman ◽  
S.A Trines ◽  
G.S De Ruiter ◽  
M Khan ◽  
...  
Keyword(s):  
Sinus Rhythm ◽  
Pulmonary Vein ◽  
Atrial Arrhythmia ◽  
Wilcoxon Test ◽  
Continuous Group ◽  
Loop Recorder ◽  
Long Term Follow Up ◽  
Rhythm Monitoring

Abstract Background Catheter ablation in patients with long-standing persistent AF (LSPAF) remains challenging and often requires repeated procedures with variable results. We report long-term outcomes of a bipolar thoracoscopic pulmonary vein and left atrial posterior wall ablation for LSPAF, and compare continuous and interval rhythm monitoring. Methods Seventy-seven LSPAF patients who underwent thoracoscopic pulmonary vein and box isolation between 2009–2017 in two Dutch centers were included. Follow-up consisted of continuous rhythm monitoring using an implanted loop recorder or 24-h Holter at 3/6/12/24/60 months. Results Mean age was 59±8 years with a median AF duration of 3.8 [1.2–6.3] years. In the total cohort, at 2-year follow-up, 86.0% of patients were in sinus rhythm, 12.3% were in paroxysmal AF and 1.6% in persistent AF. At 5 years, 62.9% of patients were in sinus rhythm, 20.0% in paroxysmal AF, 14.3% in persistent AF and 2.9% was experiencing atrial flutter. Continuous rhythm monitoring was performed in 46% of patients. Comparing continuous and interval rhythm monitoring, freedom from any atrial arrhythmia episode at 2- and 5 years was 60.0% and 49.9% in the continuous group and 93.8% and 51.9% in the interval monitoring group, respectively (p=0.02, Breslow-Wilcoxon test). In patients with continuous rhythm monitoring the mean atrial arrhythmia burden was reduced from 99.1% preoperatively to 0.1% at the end of the blanking period and 7.3% at 2-year follow-up. Conclusions Thoracoscopic box ablation is highly effective in restoring sinus rhythm at medium term follow-up. However, it is not a curative treatment as demonstrated by the 50% arrhythmia-free survival at long-term follow-up. Whether this is due to the progressive nature of AF needs further investigation. Continuous rhythm monitoring shows earlier recurrence detection with a potential early treatment adaptation. Funding Acknowledgement Type of funding source: None

Electrical characteristics of pacing different portions of the His bundle in bradycardia patients

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_2) ◽  
pp. ii27-ii35
Author(s):  
Yiran Hu ◽  
Min Gu ◽  
Wei Hua ◽  
Hongxia Niu ◽  
Hui Li ◽  
...  
Keyword(s):  
Wave Amplitude ◽  
Electrical Characteristics ◽  
Normal Range ◽  
Tricuspid Valve Regurgitation ◽  
His Bundle ◽  
His Bundle Pacing ◽  
Pacing Mode ◽  
Echocardiographic Assessment ◽  
R Wave Amplitude

Abstract Aims His-bundle pacing (HBP) can be achieved in either atrial-side HBP (aHBP) or ventricular-side HBP (vHBP). The study compared the pacing parameters and electrophysiological characteristics between aHBP and vHBP in bradycardia patients. Methods and results Fifty patients undergoing HBP implantation assisted by visualization of the tricuspid valvular annulus (TVA) were enrolled. The HBP lead position was identified by TVA angiography. Twenty-five patients were assigned to undergo aHBP and compared with 25 patients who underwent vHBP primarily in a prospective and randomized fashion. Pacing parameters and echocardiography were routinely assessed at implant and 3-month follow-up. His-bundle pacing was successfully performed in 45 patients (90% success rate with 44.4% aHBP and 55.6% vHBP). The capture threshold was lower in vHBP than aHBP at implant (vHBP: 1.1 ± 0.5 vs. aHBP: 1.4 ± 0.4 V/1.0 ms, P = 0.014) and 3-month follow-up (vHBP: 0.8 ± 0.4 vs. aHBP: 1.7 ± 0.8 V/0.4 ms, P &lt; 0.001). The R-wave amplitude was higher in vHBP than in aHBP at implant (vHBP: 4.5 ± 1.4 vs. aHBP: 2.0 ± 0.8 mV, P &lt; 0.001) and at 3-month follow-up (vHBP: 4.4 ± 1.5 vs. aHBP: 1.8 ± 0.7 mV, P &lt; 0.001). No procedure-related complications and aggravation of tricuspid valve regurgitation were observed in most patients and echocardiographic assessment of cardiac function remained in the normal range in all patients during the follow-up. Conclusion This study demonstrates that vHBP features a low and stable pacing capture threshold and high R-wave amplitude, suggesting better pacing mode management and battery longevity can be achieved by HBP in the ventricular side.

P2878Higher all-cause mortality in patients with implanted dual-chamber cardioverter-defibrillators for secondary prevention: an analysis from the Polish ICD Registry

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
I Warchol ◽  
A Lubinski ◽  
M Sterlinski ◽  
O Kowalski ◽  
K Goscinska-Bis ◽  
...  
Keyword(s):  
Secondary Prevention ◽  
Implantable Cardioverter Defibrillators ◽  
Dual Chamber ◽  
Single Chamber ◽  
Kaplan Meier ◽  
Significant Difference ◽  
All Cause Mortality ◽  
National Cohort ◽  
Cardioverter Defibrillators

Abstract Background In the Polish ICD Registry population secondary prevention recipients account for over 27%. Despite the evolution of indications for secondary prevention implantable cardioverter defibrillators (ICDs), recommendations regarding the use of ICDs for secondary prevention of sudden cardiac death (SCD) rely on information from a small number of randomized controlled trials that were performed decades ago, with mixed results. Moreover, research on the outcomes after implantations for secondary prevention of ICDs is limited. While dual-chamber devices offer theoretical advantage over single-chamber devices, dual-chamber ICDs (DC-ICDs) were announced not superior to single-chamber (SC-ICDs) in some research. Purpose Therefore, the aim of the study was to evaluate the all-cause mortality among patients from the Polish ICD Registry receiving either a single- or a dual-chamber device for secondary prevention in contemporary clinical practice. Methods All patients enrolled in the Polish ICD Registry from 1995 to 2016 were identified. Patients were included in the study if they were designated as receiving an ICD for secondary prevention of SCD after documented tachycardic arrest, sustained ventricular tachycardia (VT), or syncope. Kaplan-Meier survival analysis was used to assess all-cause mortality. Results In the study population of 3596 ICD recipients (mean age 69±12 years, 81% male, SC-ICD 61%, DC-ICD 39%), during mean follow-up of 79±43 months all-cause mortality rate was higher in the dual-chamber group than in the single chamber group, with a significant difference between the two groups as depicted in Kaplan-Meier curve (p<0,05). The median survival time was 98 months versus 110 months for SC and DC-ICD, respectively. Conclusions This study is the first to describe the characteristics of a national cohort of patients receiving a secondary prevention ICD in such a long follow-up period in contemporary practice. Implantation of a dual-chamber ICD was associated with higher all-cause mortality compared with single chamber devices.

Programming and follow-up of patients with His bundle pacing

2020 ◽  
Vol 31 (2) ◽  
pp. 177-182 ◽  
Author(s):  
Elise Bakelants ◽  
Alwin Zweerink ◽  
Haran Burri
Keyword(s):  
His Bundle ◽  
His Bundle Pacing
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