Learning Curve and Initial Experience With Implementation of a His-Bundle Pacing Program in an Australian Setting

Dawson, L.; Cadden, Julie; Pol, D.; Wynn, Gareth J.; Grigg, Leeanne; Kalman, Jonathan M.; Stevenson, Irene H.

doi:10.1016/j.hlc.2020.01.003

Cited by 4 publications

(3 citation statements)

References 15 publications

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“…Two-dimensional imaging struggles with leads coursing in an oblique plane and with tip localization. Pinning of the septal tricuspid valve leaflet is a known complication of HBP, 8 , 9 particularly when the delivery system is advanced from atrium to ventricle while searching for the His electrogram. Pediatric patients may have an additional risk of valvar regurgitation, as lead redundancy is required to accommodate for future growth.…”

Section: Discussionmentioning

confidence: 99%

Use of adjunctive 3-dimensional echocardiogram for His bundle pacing in pediatric patients

Alvensleben

Runciman²,

Schaffer³

et al. 2023

HeartRhythm Case Reports

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Section: Discussionmentioning

confidence: 99%

Use of adjunctive 3-dimensional echocardiogram for His bundle pacing in pediatric patients

Alvensleben

Runciman²,

Schaffer³

et al. 2023

HeartRhythm Case Reports

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“…Our institution has previously reported procedural techniques for HBP 5 . In brief, all HBP procedures were performed via subclavian access using a 69 cm Medtronic SelectSecure 3830 pacing lead (Medtronic) and a preformed non‐steerable sheath (Medtronic C315 His).…”

Section: Methodsmentioning

confidence: 99%

“…Our institution has previously reported procedural techniques for HBP. 5 In brief, all HBP procedures were performed via subclavian access using a 69 cm Medtronic SelectSecure 3830 pacing lead (Medtronic) and a preformed non‐steerable sheath (Medtronic C315 His). His location was determined through the identification of a His bundle potential through the catheter/lead system via the Model 2090 Medtronic Pacemaker and ICD Programmer (Medtronic) and/or the Bard Labsystem Pro electrophysiology mapping system (Boston Scientific).…”

Section: Methodsmentioning

confidence: 99%

His bundle combined with deep septal left bundle branch area pacing for atrial fibrillation prior to atrioventricular node ablation

Nam

O'Sullivan

Tonchev

et al. 2022

Journal of Arrhythmia

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Background: To mitigate the risk of dyssynchrony-induced cardiomyopathy, international guidelines advocate His bundle pacing (HBP) with a ventricular backup lead prior to atrioventricular node ablation in treatment-refractory atrial fibrillation and normal left ventricular ejection fraction. As a result of concerns with long-term pacing parameters associated with HBP, this case series reports an adopted strategy of HBP combined with deep septal left bundle branch area pacing (dsLBBAP) in this patient cohort, enabling intrapatient comparison of the two pacing methods. Methods and Results:Eight patients aged 72 ± 10 years (left ventricular ejection fraction 53 ± 4%) underwent successful combined HBP and dsLBBAP implant prior to AV node ablation. Intrinsic QRS duration was 118 ± 46 ms. When compared to dsLBBAP, HBP had lower sensed ventricular amplitude (2.4 ± 1.1 vs. 15 ± 5.3 V, p = .001) and lower lead impedance (522 ± 57 vs. 814 ± 171ohms, p = .02), but shorter paced QRS duration (101 ± 20 vs. 119 ± 17 ms, p = .02). HBP pacing threshold was 1.0 ± 0.6 V at 1 ms pulse width, and dsLBBAP pacing threshold was 0.5 ± 0.2 V at 0.4 ms pulse width.Five patients underwent cardiac CT showing adequate dsLBBAP ventricular septal penetration (8.6 ± 1.3 mm depth, 2.4 ± 0.5 mm distance from left ventricular septal wall). No complications occurred during a mean follow-up duration of 121 ± 92 days. Conclusions:Combined HBP and dsLBBAP pacing is a feasible approach as a pace and ablate strategy for atrial fibrillation refractory to medical therapy.

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Adopting permanent His bundle pacing: learning curves and medium-term outcomes

et al. 2021

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Aims This study aims to determine procedural characteristics, acute success rates, and medium-term outcomes of consecutive patients undergoing His bundle pacing (HBP); and learning curves of experienced electrophysiologists adopting HBP. Methods and results Consecutive HBP patients at three hospitals were recruited. Clinical characteristics, acute procedural details, and medium-term outcomes were extracted from electronic medical records. Two hundred and thirty-three patients [mean age 74.6 ± 10.1 years, 48% female, 68% narrow QRS, 71% normal left ventricular ejection fraction (LVEF), 55.8% atrioventricular block] underwent HBP. Acute procedural success was 81.1% (mean procedural and fluoroscopic times of 105.5 ± 36.5 and 13.8 ± 9.3 min). Broad QRS was associated with lower HBP success (odds ratio 0.39, P = 0.02). Fluoroscopic and procedural times decreased and plateaued after 30–40 cases per operator. Implant HBP threshold was 1.3 ± 0.7 V at 1.0 ± 0.2 ms and R wave was 5.0 ± 3.9 mV. During follow-up, loss of HBP occurred in a further 12.4% and 11.3% of patients experienced a ≥1 V increase in HBP threshold. Five (2.6%) patients required HBP revision for pacing difficulties. About 8.6% of patients had a >50% decrease in R wave but lead revision for sensing issues was not necessary. On an intention to treat basis, 56.7% of patients in whom HBP was attempted had persisting HBP capture and thresholds of <2 V. Conclusion Physicians adopting HBP should be cognizant of the learning curve and preferentially select non-dependent patients with normal QRS and LVEF, to minimize risk of lead revision. Further rises in HBP threshold may increase battery drain and need for reoperations, important considerations when choosing HBP for cardiac resynchronization therapy.

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Learning Curve and Initial Experience With Implementation of a His-Bundle Pacing Program in an Australian Setting

Cited by 4 publications

References 15 publications

Use of adjunctive 3-dimensional echocardiogram for His bundle pacing in pediatric patients

Use of adjunctive 3-dimensional echocardiogram for His bundle pacing in pediatric patients

His bundle combined with deep septal left bundle branch area pacing for atrial fibrillation prior to atrioventricular node ablation

Adopting permanent His bundle pacing: learning curves and medium-term outcomes

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