Long term performance and safety of His bundle pacing: A multicenter experience

Zanon, Francesco; Abdel‐Rahman, Mohamed H.; Marcantoni, Lina; Naperkowski, Angela; Subzposh, Faiz A.; Pastore, Gianni; Baracca, Enrico; Boaretto, Graziano; Raffagnato, Paola; Tiribello, Antonella; Dandamudi, Gopi; Vijayaraman, Pugazhendhi

doi:10.1111/jce.14063

Cited by 123 publications

(120 citation statements)

References 36 publications

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“…Given that HBP has been performed more widely, large registries have collated international experience to provide a picture of contemporary practice, including indications. [ 6 , 12 , 13 ] In the Keene et al multicentre registry of 529 patients, AVB was the most common indication, seen in half of cases, with slow AF the next most common (27.8%). [ 13 ] The remainder of the patients had CRT, SND and AVNA in similar proportions (6.6–8.9%).…”

Section: Potential Indications For Conduction System Pacingmentioning

confidence: 99%

His–Purkinje Conduction System Pacing: State of the Art in 2020

Arnold

Whinnett

Vijayaraman

2020

Arrhythm Electrophysiol Rev

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Conduction system pacing involves directly stimulating the specialised His–Purkinje cardiac conduction system with the aim of activating the ventricles physiologically, in contrast to the dyssynchronous activation produced by conventional myocardial pacing. Since the first report of permanent His bundle pacing (HBP) in 2000, the stylet-driven technique of its earliest incarnation has been superseded by a more successful stylet-less approach. Widespread uptake has led to a much greater evidence base. Single-centre observational studies have now been supported by large multicentre, international registries, mechanistic studies and the first randomised controlled trials. New evidence has elucidated mechanisms of HBP and illustrated the nature and magnitude of its potential benefits for preventing pacing-induced cardiomyopathy and correcting bundle branch block. Left bundle branch pacing (LBBP) is a newer technique in which the lead is fixed deep into the left side of the intraventricular septum to allow capture of the left bundle, distal to the His bundle. LBBP holds promise as a method for physiological pacing that overcomes some of the fixation, threshold and sensing challenges of HBP. In this state-of-the-art review of His–Purkinje conduction system pacing, the authors assess recent evidence and current practice and explore emerging and future directions in this rapidly evolving field.

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Section: Potential Indications For Conduction System Pacingmentioning

confidence: 99%

His–Purkinje Conduction System Pacing: State of the Art in 2020

Arnold

Whinnett

Vijayaraman

2020

Arrhythm Electrophysiol Rev

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“…However, the capture threshold is often higher in this region compared to right ventricular pacing sites while R‐wave amplitudes are generally lower . Furthermore, an increasing capture threshold remains a challenge with HBP . Recently, pacing at more distal portion of the conduction system, targeting the left bundle branch called left bundle branch pacing (LBBP) has been reported and might be an alternative to HBP to maintain the left ventricular electrical synchrony using a low and stable pacing output.…”

Section: Introductionmentioning

confidence: 99%

Electrophysiological parameters and anatomical evaluation of left bundle branch pacing in an in vivo canine model

Chen

Jin

et al. 2019

Cardiovasc electrophysiol

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Introduction: Left bundle branch pacing (LBBP), a form of conduction system pacing in addition to His bundle pacing (HBP), can potentially maintain left ventricular electrical synchrony with better sensing and a low and stable capture threshold. Methods:We performed both HBP and LBBP using a canine model (n = 3; male;weight 30-40 kg). The electrocardiogram (ECG), intracardiac electrogram characteristics, and pacing parameters were compared between HBP and LBBP. The hearts were isolated and stained by Lugol's iodine (5%) to assess the relative locations of the leads in relation to the conduction system. Results:The average potential to ventricle interval was longer with HBP compared to LBBP (26.67 ± 3.06 ms vs 12.67 ± 1.15 ms; P = .002). There were also notable differences in the pacing parameters between HBP and LBBP: R-wave amplitude (2.67 ± 0.42 mV vs 11.33 ± 3.06 mV; P = .008), pacing impedance (423.3 ± 40.4 vs 660.0 ± 45.8; P = .003), and threshold (2.30 ± 0.66 V/0.4ms vs 0.67 ± 0.15 V/0.4 ms; P = .014). The paced morphology of ECG was similar to the intrinsic with HBP while a right bundle branch block pattern was noted with LBBP. The anatomical evaluation revealed the location of the leads and the average lead depth was significantly more with LBBP as compared to HBP (12.33 ± 1.53 mm vs1.83 ± 0.29 mm; P < .0001). Furthermore, with LBBP, the tip of the lead helix was noted to be around the LBB. Conclusion:This in vivo canine model study confirms the significant differences between HBP and LBBP. Furthermore, this model provides a precise anatomic evaluation of the location and the depth of the leads in relation to the conduction system. K E Y W O R D S anatomical evaluation, canine model, conduction system pacing, electrocardiogram, His bundle pacing, left branch bundle pacing SUPPORTING INFORMATION Additional supporting information may be found online in the Supporting Information section. How to cite this article: Chen X, Jin Q, Li B, et al. Electrophysiological parameters and anatomical evaluation of left bundle branch pacing in an in vivo canine model.

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“…Abdelrahman et al 16 have highlighted the superiority of HBP compared with the traditional RV pacing sites in terms of a combined end point including all‐cause mortality, HF hospitalizations and upgrading to cardiac resynchronization therapy, during a mean follow‐up of 2 years. Both feasibility and safety of HBP has been widely described in nonrandomized trials, as well as its reliability on long‐term follow‐up 15–19 . The time spent to localize the His bundle and fix up the lead represents one of the main technical concern, and was thought to result in a prolonged procedure with high FT.…”

Section: Discussionmentioning

confidence: 99%

“…Nowadays it is possible to safely and efficiently perform zero X-ray arrhythmia ablation thanks to mapping system. 11 [15][16][17][18][19] The time spent to localize the His bundle and fix up the lead represents one of the main technical concern, and was thought to result in a prolonged procedure with high FT. In a series of lower FT in patients with successful HBP compared with those subjects with unsuccessful HBP (10 ± 7 vs 24 ± 1 minutes, respectively).…”

Section: Discussionmentioning

confidence: 99%

Electrogram‐only guided approach to His bundle pacing with minimal fluoroscopy: A single‐center experience

Zanon

Marcantoni

Zuin

et al. 2020

Cardiovasc electrophysiol

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Introduction His bundle pacing (HBP) is the most physiological pacing. The standard technique based on fluoroscopic approach might be challenging and fluoro consuming. Targeting the His guided exclusively by the electrical signals could enable a precise lead implant, thus reducing fluoroscopy time (FT) and X‐ray dose, desirable both for patients and operators. The aim of the study is to evaluate the feasibility, efficacy, and safety both acutely and at 30 days of the electrogram (EGM)‐guided HBP with minimal or no fluoroscopy. Methods and Results Between October and December 2018, 41 consecutive patients underwent EGM‐guided HBP. Successful HBP was obtained in 39 (95%) patients, (30 males, 78 ± 10 years). Selective HBP (S‐HBP) was achieved in 23 (59%), nonselective HBP (NS‐HBP) in 16 (41%) patients. The final HBP lead position was reached in 31 (79.4%) patients without fluoroscopy, only guided by electrical signals. In eight patients a minimal fluoroscopy (mean, 8 seconds) has been required. The sheath's cutting and the slack of the lead were routinely performed under fluoroscopy. No difference was observed in FT for HBP lead placement in S‐HBP and NS‐HBP (mean, 8.1 ± 25 vs 7.5 ± 20 seconds, P = .8; median value 0 vs 0 seconds). No differences were observed in FT for the entire procedure, total dose area product and total procedural time in S‐HBP and NS‐HBP. Lead dislodgement occurred in one (2.6%) patient 1 day after the procedure. Conclusions HBP could be performed safely and efficiently using the EGMs, with minimal or no fluoroscopy. Fluoroscopy was required during sheath removal and atrial lead placement.

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Long term performance and safety of His bundle pacing: A multicenter experience

Cited by 123 publications

References 36 publications

His–Purkinje Conduction System Pacing: State of the Art in 2020

His–Purkinje Conduction System Pacing: State of the Art in 2020

Electrophysiological parameters and anatomical evaluation of left bundle branch pacing in an in vivo canine model

Electrogram‐only guided approach to His bundle pacing with minimal fluoroscopy: A single‐center experience

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