Permanent His-bundle pacing as an alternative to biventricular pacing for cardiac resynchronization therapy: A multicenter experience

Sharma, Parikshit S.; Dandamudi, Gopi; Herweg, Bengt; Wilson, David R.; Singh, Rajeev; Naperkowski, Angela; Koneru, Jayanthi N.; Ellenbogen, Kenneth A.; Vijayaraman, Pugazhendhi

doi:10.1016/j.hrthm.2017.10.014

Cited by 351 publications

(320 citation statements)

References 20 publications

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“…New delivery mechanisms allow stimulation of the LV septum via transvenous access [134] meaning this approach may well become increasingly widespread. Whether similar results can be achieved through selective His capture in the RV remains to be seen, although initial studies of this promising pacing modality appear promising [148]. …”

Section: Expert Commentarymentioning

confidence: 99%

Optimal site selection and image fusion guidance technology to facilitate cardiac resynchronization therapy

Sieniewicz

Gould

Porter

et al. 2018

Expert Review of Medical Devices

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Introduction: Cardiac resynchronization therapy (CRT) has emerged as one of the few effective treatments for heart failure. However, up to 50% of patients derive no benefit. Suboptimal left ventricle (LV) lead position is a potential cause of poor outcomes while targeted lead deployment has been associated with enhanced response rates. Image-fusion guidance systems represent a novel approach to CRT delivery, allowing physicians to both accurately track and target a specific location during LV lead deployment.Areas covered: This review will provide a comprehensive evaluation of how to define the optimal pacing site. We will evaluate the evidence for delivering targeted LV stimulation at sites displaying favorable viability or advantageous mechanical or electrical properties. Finally, we will evaluate several emerging image-fusion guidance systems which aim to facilitate optimal site selection during CRT.Expert commentary: Targeted LV lead deployment is associated with reductions in morbidity and mortality. Assessment of tissue characterization and electrical latency are critical and can be achieved in a number of ways. Ultimately, the constraints of coronary sinus anatomy have forced the exploration of novel means of delivering CRT including endocardial pacing which hold promise for the future of CRT delivery.

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Section: Expert Commentarymentioning

confidence: 99%

Optimal site selection and image fusion guidance technology to facilitate cardiac resynchronization therapy

Sieniewicz

Gould

Porter

et al. 2018

Expert Review of Medical Devices

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show abstract

“…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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“…Permanent His bundle pacing has been considered as a physiological pacing modality that produces synchronized ventricular activation. However, various studies on HBP have also revealed a challenging implantation procedure that negatively affects the success rate of the implantation with acceptable pacing parameters . Anatomic investigations have found that the His bundle is compressed in a narrow diameter of approximately 1 mm and travels inside the membranous atrioventricular septum that consists of thick connective tissue, then reaches the basal IVS where there is myocardial tissue.…”

Section: Discussionmentioning

confidence: 99%

Visualization of tricuspid valve annulus for implantation of His bundle pacing in patients with symptomatic bradycardia

Hua

et al. 2019

Cardiovasc electrophysiol

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Background His bundle pacing (HBP) is a physiological pacing modality, but HBP implantation remains a challenge. Objective This study explored the feasibility of using visualization of the tricuspid valve annulus (TVA) to locate the site for HBP. Methods During the lead placement in eight patients with symptomatic bradycardia, the TVA and tricuspid septal leaflet was revealed by contrast injection in the right ventricle under the fluoroscopic right anterior oblique view, and the target site for HBP was identified near the intersection of the tricuspid septal leaflet and the interventricular septum. On the basis of the imaging marker, the pacing lead was placed for HBP at either the atrial (aHBP) or ventricular side (vHBP). Results During the implantation, the pacing lead placement was attempted for aHBP in two patients, vHBP in five patients, and first for aHBP then vHBP in one patient. The aHBP was selective and had a capture threshold of 1.6 ± 0.5 V@ 1.0ms and R‐wave amplitude of 1.2 ± 0.4 mV. Ventricular‐side His bundle capture was selective in four patients and nonselective in two patients. The vHBP capture threshold was 0.8 ± 0.4 V@ 1.0ms (P < .05 vs aHBP) and R‐wave amplitude was 4.1 ± 1.5 mV (P < .05 vs aHBP). At the final pacing programming of 3.0 V@ 1.0ms, vHBP was nonselective in all six patients and aHBP remained selective in two patients. Pacing parameters remained stable at 3 months. Conclusion The location of the TVA and tricuspid septal leaflet revealed by right ventriculography can be used as a landmark to identify the HBP site.

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Permanent His-bundle pacing as an alternative to biventricular pacing for cardiac resynchronization therapy: A multicenter experience

Cited by 351 publications

References 20 publications

Optimal site selection and image fusion guidance technology to facilitate cardiac resynchronization therapy

Optimal site selection and image fusion guidance technology to facilitate cardiac resynchronization therapy

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

Visualization of tricuspid valve annulus for implantation of His bundle pacing in patients with symptomatic bradycardia

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