His Bundle Pacing

Vijayaraman, Pugazhendhi; Chung, Mina K.; Dandamudi, Gopi; Upadhyay, Gaurav A.; Krishnan, K. Ranga Rama; Crossley, George H.; Campbell, Kevin R; Lee, Byron K.; Refaat, Marwan M.; Saksena, Sanjeev; Fisher, John D.; Lakkireddy, Dhananjaya

doi:10.1016/j.jacc.2018.06.017

Cited by 289 publications

(243 citation statements)

References 57 publications

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“…His bundle pacing (HBP), which utilizes the native cardiac conduction system, is physiological and has demonstrated clinical benefits in bradycardia and even patients with heart failure . However, HBP has some limitations, such as operational difficulty with relatively long fluoroscopic exposure times and sometimes high and unstable pacing capture threshold . Moreover, HBP often fails to provide adequate pacing in patients with infra‐Hisian block or proximal left bundle branch block (LBBB).…”

Section: Introductionmentioning

confidence: 99%

How to implant left bundle branch pacing lead in routine clinical practice

Chen

2019

Cardiovasc electrophysiol

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Introduction Left bundle branch pacing (LBBP) is characterized with a low and stable pacing capture threshold, relatively narrow QRS duration due to fast left ventricular activation, and direct excitation of the diseased left bundle branch. This report aims to describe the methods, procedural skills, and clinical implications of performing LBBP implantation. Methods and Results LBBP is achieved by transventricular‐septal approach. There are two methods to identify the location for LBBP lead placement: the single‐lead method and the dual‐lead method. During implantation, the unique transition of the paced QRS morphology and pacing parameter changes are important for guiding the lead ‐ advancement to the left side of the interventricular septum. In our experience, LBBP can be safely performed in most patients requiring pacemaker therapy. Conclusion Clinical development of LBBP is at an early but encouraging phase with increasing clinical use, and a standardized procedure with improved delivery tools and pacing leads is needed, as well as long‐term efficacy and safety.

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Section: Introductionmentioning

confidence: 99%

How to implant left bundle branch pacing lead in routine clinical practice

Chen

2019

Cardiovasc electrophysiol

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“…In two patients implanted with HBP, surface ECG showed various waveforms depending on the applied energy, which could be reproduced by introducing a block or delay in either the RBB or LBB. Variations in ECG waveforms under HB pacing are explained by the spatial distribution of the electrical field and the longitudinal dissociation of the HB . The LBBB pattern that was observed in case 1 under low voltage could be described as “super‐selective” right bundle pacing using this scheme (Figure A).…”

Section: Resultsmentioning

confidence: 95%

“…In the following pacing simulations, we did not change these parameters. 22 The LBBB pattern that was observed in case 1 under low voltage could be described as "super-selective" right bundle pacing using this scheme ( Figure 7A). However, the observation made in case 2 was difficult to understand using the same scheme because the conduction delay or block appeared to occur in the RBB rather than in the LBB.…”

Section: Simulation Of the Local Electrical Fieldmentioning

confidence: 88%

“…HBP can normalize LBBB in some patients and thus potentially replace biventricular pacing for cardiac resynchronization therapy. 22 Moreover, recent clinical studies have reported high success rates (up to 90%) for correction of LBBB by HBP. 7,24 This finding suggests that conduction block of the LBB occurs in the proximal portion of the His-Purkinje system in the majority of cases.…”

Section: Clinical Implicationmentioning

confidence: 99%

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Longitudinal dissociation and transition in thickness of the His‐Purkinje system cause various QRS waveforms of surface ECG under His bundle pacing: A simulation study based on clinical observations

Okada

Fujiu

Washio

et al. 2019

Cardiovasc electrophysiol

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Aims His bundle pacing (HBP) is a feasible and reliable alternative to conventional right ventricular pacing (RVP), but associated ECG (electrocardiogram) changes have not been well‐studied. This study aimed to determine the mechanisms underlying ECG changes associated with HBP using patient‐specific multiscale heart simulations. Methods ECGs were recorded in two patients who were treated by HBP under a native rhythm and HBP at high and low voltages. We created patient‐specific multiscale simulation heart models of these patients and performed ECG simulation under these conditions. Using these results and detailed information on the electrical field around the pacing lead, we investigated mechanisms underlying the observed ECG changes. Results Heart simulations successfully reproduced ECGs under a native rhythm for both cases. In case 1, nonselective HBP produced a left bundle branch (LBB) block pattern, which was reproduced as a selective right bundle branch (RBB) pacing. However, in case 2, ECG under nonselective HBP showed an RBB block pattern, which could not be reproduced by the commonly used framework. Findings on the electrical field and anatomy of the His bundle and its branches suggested that longitudinal dissociation of the His bundle and transition of thickness in the stem of the LBB caused a conduction delay in the RBB to produce these ECG changes in this patient. Conclusion Variations in the anatomy of the His bundle and its branches may underlie the diverse ECG responses to HBP. These variations should be taken into account when performing this therapy.

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“…Compared with conventional right ventricular pacing (RVP), HBP can shorten the pacing QRS duration and induce physiological ventricular activation, resulting in reduction of ventricular and atrioventricular dyssynchronies and hemodynamic improvement . The clinical application of HBP in humans has been recently initiated; the use of recently introduced and specially designed pacing lead and sheath can help in performing HBP with reasonable success rates …”

Section: Introductionmentioning

confidence: 99%

Study design and protocol for evaluating the long‐term prognosis of patients receiving his bundle pacing: A multicenter observational study

Inden

Kato

Suzuki

et al. 2019

Journal of Arrhythmia

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Background His bundle pacing (HBP) is a recently developed pacing technique that can achieve an ideal physiological pattern of ventricular activation via stimulation of the native His‐Purkinje system. Despite the widespread introduction of HBP in clinical practice, its appropriate indications are yet to be determined clearly. Moreover, the efficacy and safety of HBP and long‐term prognosis of patients undergoing such are unknown. Methods We conducted a multicenter observational prospective study in patients undergoing HBP in Japan. Patients with atrioventricular block or conduction delay and estimated ventricular pacing of ≥ 40% scheduled for HBP implantation are included. All patients are followed up until 3 years after the implantation. The primary endpoints are all‐cause death, heart failure‐related hospitalization, and upgrade to cardiac resynchronization therapy. The secondary endpoint is changes in cardiac function based on echocardiographic findings and laboratory data after the implantation. Results The results are currently under investigation. Conclusions This multicenter observational study evaluates the long‐term prognosis and changes in cardiac function of patients undergoing HBP implantation in a clinical setting. Considering the large number of patients included, the cumulative results would be helpful in establishing evidence on HBP application in this area and consequently allow accurate management and treatment of patients undergoing HBP.

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His Bundle Pacing

Cited by 289 publications

References 57 publications

How to implant left bundle branch pacing lead in routine clinical practice

How to implant left bundle branch pacing lead in routine clinical practice

Longitudinal dissociation and transition in thickness of the His‐Purkinje system cause various QRS waveforms of surface ECG under His bundle pacing: A simulation study based on clinical observations

Study design and protocol for evaluating the long‐term prognosis of patients receiving his bundle pacing: A multicenter observational study

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