His bundle pacing insights from electroanatomical mapping: Topography and pacing targets

Orlov, Michael V.; Jahangir, Ahad; McKelvey, Daniel; Armstrong, James; Maslov, Mikhail Y.; Monin, A J; Koulouridis, Ioannis; Casavant, David; Wylie, John V.

doi:10.1111/jce.14672

Cited by 4 publications

(3 citation statements)

References 30 publications

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“…68 Moreover, efforts to circumvent the difficulties of locating the conduction system with fluoroscopy are being made by testing new 3D electro-anatomical mapping systems. 69 Recently published data is also encouraging for an electrogram-only guided approach to HBP with minimal fluoroscopy and high success rates compared to the classical method. 70 But of course, the need for data collection through conducting large RCTs, which will prove the significant benefit of this pacing in clinical endpoints of hospitalizations and mortality, should not be overlooked.…”

Section: Looking To the Futurementioning

confidence: 90%

Conduction System Pacing: How far are we from the “electrical” bypass?

Sdogkos

Iliodromitis²,

Xanthopoulos

et al. 2023

Preprint

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Conduction system pacing is an alternative practice to conventional right ventricular apical pacing. It is a method that maintains physiologic ventricular activation, based on a correct pathophysiological basis, in which the pacing lead bypasses the lesion of the electrical fibers, and the electrical impulse transmits through the intact adjacent conduction system. For this reason, it might reasonably characterized by the term “electrical bypass” compared to the coronary artery bypass in revascularization therapy. In this review reference is made to the sequence of events that conventional right ventricular pacing may cause adverse outcomes. Furthermore, there is a reference to alternative strategies and pacing sites. Interest focuses on the modalities for which there is data from the literature, namely for the Right Ventricular (RV) septal pacing, the His Bunde pacing (HBP), and the Left Bundle Branch pacing (LBBP). A more extensive reference is about the HBP, for which there are the most updating data. We analyze the considerations that limit HBP wide application in three axes, and we also present the data for the implantation and follow-up of these patients. Then, the indications with their most important studies to date are described in detail, not only in their undoubtedly positive findings but also in their weak aspects, because of which, this pacing mode has not yet received a strong recommendation for implementation. Finally, there is a report on LBBP, focusing mainly on its points of differentiation from HBP.

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Section: Looking To the Futurementioning

confidence: 90%

Conduction System Pacing: How far are we from the “electrical” bypass?

Sdogkos

Iliodromitis²,

Xanthopoulos

et al. 2023

Preprint

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“…Therefore, it has been speculated that in NS-HBP the tissue activated local to the right-sided His bundle and the right-sided His lead electrode would be right ventricular myocardium. 10 Thus, RV activation would be mainly affected by NS-HBP, preserving LV synchrony. Whereas in RVP, BVP, and BBB (other causes of wide QRS), dyssynchronous left ventricular activation is expected and has been observed.…”

Section: Discussionmentioning

confidence: 99%

Left ventricular activation time and pattern are preserved with both selective and nonselective His bundle pacing

et al. 2021

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This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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“…Although feasibility trials and retrospective studies have shown promising results, the role of EAM in routine practice for physiologic lead placement requires further investigation 7–10,13,14 . The additional time needed to create electroanatomic maps and associated financial costs should be considered when selecting appropriate patients.…”

Section: Discussionmentioning

confidence: 99%

Physiologic lead placement with electroanatomic mapping: A case series

Baman

Garg

Kalluri

et al. 2021

Cardiovasc electrophysiol

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Introduction His bundle pacing (HBP) and left bundle branch area pacing (LBBAP) have emerged as attractive alternatives to traditional biventricular pacing to achieve cardiac resynchronization therapy. Early reported results have been inconsistent, particularly amongst patients in whom initial placement with traditional approaches has been unsuccessful or those with complex anatomy or congenital abnormalities. In this report, we describe the use of three‐dimensional electroanatomic mapping (EAM) in five selected cases. Methods Five patients from multiple clinical sites underwent EAM‐guided HBP or LBBAP by highly trained electrophysiologists with significant experience with conduction system pacing. Each patient in this series underwent EAM‐guided conduction system pacing due to complex anatomy and/or prior failed lead implantation. Results EAM‐guided lead implantation was successful in all five cases. Capture thresholds were relatively low and patients continued to have evidence of successful lead implantation with minimum 1‐month follow‐up. The fluoroscopy time varied, likely owing to the variable complexity of the cases. Conclusions The use of EAM, in combination with traditional intracardiac electrograms with or without fluoroscopy, allows more targeted and precise placement of leads for HBP and LBBAP pacing. Further investigation is needed to determine this strategy's long‐term performance and to optimize patient selection.

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His bundle pacing insights from electroanatomical mapping: Topography and pacing targets

Cited by 4 publications

References 30 publications

Conduction System Pacing: How far are we from the “electrical” bypass?

Conduction System Pacing: How far are we from the “electrical” bypass?

Left ventricular activation time and pattern are preserved with both selective and nonselective His bundle pacing

Physiologic lead placement with electroanatomic mapping: A case series

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