Permanent His bundle pacing: Recommendations from a Multicenter His Bundle Pacing Collaborative Working Group for standardization of definitions, implant measurements, and follow-up

Vijayaraman, Pugazhendhi; Dandamudi, Gopi; Zanon, Francesco; Sharma, Parikshit S.; Tung, Roderick; Huang, Weijian; Koneru, Jayanthi N.; Tada, Hiroshi; Ellenbogen, Kenneth A.; Lustgarten, Daniel L.

doi:10.1016/j.hrthm.2017.10.039

Cited by 297 publications

(259 citation statements)

References 23 publications

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“…There was no ECG core lab for confirming His capture; therefore the presence and type of His bundle capture were verified by the implanting physician according to the accepted criteria published in the His pacing consensus document . The method for measuring QRS duration was determined by the local protocol within each institution.…”

Section: Discussionmentioning

confidence: 99%

His bundle pacing, learning curve, procedure characteristics, safety, and feasibility: Insights from a large international observational study

Keene

Arnold

Jastrzębski

et al. 2019

Cardiovasc electrophysiol

146

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Background His‐bundle pacing (HBP) provides physiological ventricular activation. Observational studies have demonstrated the techniques’ feasibility; however, data have come from a limited number of centers. Objectives We set out to explore the contemporary global practice in HBP focusing on the learning curve, procedural characteristics, and outcomes. Methods This is a retrospective, multicenter observational study of patients undergoing attempted HBP at seven centers. Pacing indication, fluoroscopy time, HBP thresholds, and lead reintervention and deactivation rates were recorded. Where centers had systematically recorded implant success rates from the outset, these were collated. Results A total of 529 patients underwent attempted HBP during the study period (2014‐19) with a mean follow‐up of 217 ± 303 days. Most implants were for bradycardia indications. In the three centers with the systematic collation of all attempts, the overall implant success rate was 81%, which improved to 87% after completion of 40 cases. All seven centers reported data on successful implants. The mean fluoroscopy time was 11.7 ± 12.0 minutes, the His‐bundle capture threshold at implant was 1.4 ± 0.9 V at 0.8 ± 0.3 ms, and it was 1.3 ± 1.2 V at 0.9 ± 0.2 ms at last device check. HBP lead reintervention or deactivation (for lead displacement or rise in threshold) occurred in 7.5% of successful implants. There was evidence of a learning curve: fluoroscopy time and HBP capture threshold reduced with greater experience, plateauing after approximately 30‐50 cases. Conclusion We found that it is feasible to establish a successful HBP program, using the currently available implantation tools. For physicians who are experienced at pacemaker implantation, the steepest part of the learning curve appears to be over the first 30‐50 cases.

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Section: Discussionmentioning

confidence: 99%

His bundle pacing, learning curve, procedure characteristics, safety, and feasibility: Insights from a large international observational study

Keene

Arnold

Jastrzębski

et al. 2019

Cardiovasc electrophysiol

146

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“…The criteria for HBP were used as described in the Recommendations of the Collaborative Working Group 13. Successful correction of LBBB was defined by paced ECG morphology without LBBB manifestation.…”

Section: Methodsmentioning

confidence: 99%

Long-term outcomes of His bundle pacing in patients with heart failure with left bundle branch block

Huang

et al. 2018

Heart

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229

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“…While previous studies described selective and nonselective HBP, there is no report of prospectively looking at the association of HBP pattern and the location of HBP. This investigation found that when the pacing lead tip was placed on the atrial side of the His bundle, His bundle capture was selective, and the selective HBP remained even when the pacing output was significantly increased to 5 V. This finding suggests that the pacing electrical current failed to penetrate through the atrioventricular septum and reach the myocardial tissue in the basal IVS.…”

Section: Discussionmentioning

confidence: 99%

“…Capture threshold test was performed, starting at 5 V @ 1 ms output with decrement until loss of capture to assess HBP characteristics. The criteria for selective and nonselective HBP were based on the literature definition …”

Section: Methodsmentioning

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: Recommendations from a Multicenter His Bundle Pacing Collaborative Working Group for standardization of definitions, implant measurements, and follow-up

Cited by 297 publications

References 23 publications

His bundle pacing, learning curve, procedure characteristics, safety, and feasibility: Insights from a large international observational study

His bundle pacing, learning curve, procedure characteristics, safety, and feasibility: Insights from a large international observational study

Long-term outcomes of His bundle pacing in patients with heart failure with left bundle branch block

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

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