The Efficacy of His Bundle Pacing: Lessons Learned From Implementation for the First Time at an Experienced Electrophysiology Center

Bhatt, Advay G.; Musat, Dan; Milstein, N; Pimienta, Jacqueline; Flynn, Laura; Sichrovsky, Tina; Preminger, Mark; Mittal, Suneet

doi:10.1016/j.jacep.2018.07.013

Cited by 100 publications

(94 citation statements)

References 24 publications

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“…We did not observe any significant difference in FT among different pacing indications, although subjects with SSS had 100% success and this is probably due to the small population. Our data are in line with the results from Bhatt et al 22 where patients with more complex AV conduction disturbance had more prolonged procedure time. In nine out of 12 patients with LBBB we observed QRS narrowing and LBBB correction, this result confirms previous experiences 24 .…”

Section: Discussionsupporting

confidence: 93%

“…Recently, Su et al 21 described in a large series of patients, FTs ranging from 10 to 12 minutes according to different techniques. Bhatt et al 22 showed a lower FT in patients with successful HBP compared with those subjects with unsuccessful HBP (10 ± 7 vs 24 ± 1 minutes, respectively). A recent large multicentre study showed a mean FT 11.7 ± 12 minutes for HBP irrespective of the underlying rhythm.…”

Section: Discussionmentioning

confidence: 95%

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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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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 95%

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

Zanon

Marcantoni

Zuin

et al. 2020

Cardiovasc electrophysiol

View full text Add to dashboard Cite

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“…However, one study that investigated 21 patients with heart failure and reduced ejection fraction who were suitable candidates for CRT reported a slightly low acute success rate of HBP (76%); this may indicate a difficulty in HBP application for complex patients with several comorbidities even in specialized cardiovascular centers . Another study showed an acute success rate of 75% for the first HBP implantation by electrophysiologists and lower achievement of HBP in patients with bundle branch block and complete heart block, indicating the need for some learning curve for HBP even among electrophysiologists . Moreover, to date, the maximum follow‐up period after HBP is 5 years, and most studies have used a follow‐up duration of several years .…”

Section: Discussionmentioning

confidence: 99%

“…for the first HBP implantation by electrophysiologists and lower achievement of HBP in patients with bundle branch block and complete heart block, indicating the need for some learning curve for HBP even among electrophysiologists. 25 Moreover, to date, the maximum follow-up period after HBP is 5 years, and most studies have used a follow-up duration of several years. 13 At the chronic phase after HBP, 5 of 100 patients (5%) required lead revision during a mean follow-up period of 19 months.…”

Section: Discussionmentioning

confidence: 99%

Study design and protocol for evaluating the long‐term prognosis of patients receiving his bundle pacing: A multicenter observational study

Inden

Kato

Suzuki

et al. 2019

Journal of Arrhythmia

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Background His bundle pacing (HBP) is a recently developed pacing technique that can achieve an ideal physiological pattern of ventricular activation via stimulation of the native His‐Purkinje system. Despite the widespread introduction of HBP in clinical practice, its appropriate indications are yet to be determined clearly. Moreover, the efficacy and safety of HBP and long‐term prognosis of patients undergoing such are unknown. Methods We conducted a multicenter observational prospective study in patients undergoing HBP in Japan. Patients with atrioventricular block or conduction delay and estimated ventricular pacing of ≥ 40% scheduled for HBP implantation are included. All patients are followed up until 3 years after the implantation. The primary endpoints are all‐cause death, heart failure‐related hospitalization, and upgrade to cardiac resynchronization therapy. The secondary endpoint is changes in cardiac function based on echocardiographic findings and laboratory data after the implantation. Results The results are currently under investigation. Conclusions This multicenter observational study evaluates the long‐term prognosis and changes in cardiac function of patients undergoing HBP implantation in a clinical setting. Considering the large number of patients included, the cumulative results would be helpful in establishing evidence on HBP application in this area and consequently allow accurate management and treatment of patients undergoing HBP.

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“…In addition, there was a trend towards reduced mortality with HBP (17% vs 21%, P = .06). The limitations of this approach include challenges in device implantation, elevated pacing thresholds (leading to lead revisions and/or premature battery depletion), sensing problems and challenges with device programming, especially given certain device‐based algorithms were never intended for use with CSP . Distal CSP (often referred to as left bundle branch [LBB] pacing) offers promise as a means to overcome many of these limitations.…”

Section: Prevention Of Pacing‐induced Cardiomyopathymentioning

confidence: 99%

Pacing induced cardiomyopathy

Merchant

Mittal

2019

Cardiovasc electrophysiol

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Pacing induced cardiomyopathy (PICM) is most commonly defined as a drop in left ventricle ejection fraction (LVEF) in the setting of chronic, high burden right ventricle (RV) pacing. Recent data suggest, however, that some individuals may experience the onset of heart failure symptoms more acutely after pacemaker implantation.Definitions of PICM which emphasize drop in LVEF may underestimate the incidence of deleterious effects from RV pacing. Treatment of PICM has primarily focused on upgrade to cardiac resynchronization therapy (CRT) when LVEF has dropped.However, emerging data suggest that conduction system pacing (CSP) may offer an opportunity to prevent PICM in the first place.cardiac resynchronization therapy, cardiomyopathy, conduction system pacing, device upgrade, dyssynchrony, his bundle pacing, left bundle branch block, pacemaker

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The Efficacy of His Bundle Pacing: Lessons Learned From Implementation for the First Time at an Experienced Electrophysiology Center

Cited by 100 publications

References 24 publications

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

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

Study design and protocol for evaluating the long‐term prognosis of patients receiving his bundle pacing: A multicenter observational study

Pacing induced cardiomyopathy

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