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A feasible approach for direct his-bundle pacing using a new steerable catheter to facilitate precise lead placement
Francesco Zanon1, Enrico Baracca, Silvio Aggio
1Division of Cardiology, Rovigo General Hospital, Rovigo, Italy. franc.zanon@iol.it
Insights
Direct His-bundle pacing (DHBP) is a feasible technique for patients with heart block, offering a potential alternative to traditional pacing methods. This study demonstrated a high success rate using a novel catheter and lead system.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Devices
Background:
- Right ventricular apical pacing negatively impacts left ventricular function.
- Preserving the His-Purkinje system is ideal for AV node block but not for His-Purkinje disease.
Purpose of the Study:
- To assess the feasibility of direct His-bundle pacing (DHBP).
- To evaluate a new system comprising a steerable catheter and a 4.1 F screw-in lead for DHBP.
Main Methods:
- DHBP was attempted in 26 patients with standard pacemaker indications and preserved His-bundle conduction.
- The study utilized a new steerable catheter and a 4.1 F screw-in lead.
- Procedure and lead positioning times, fluoroscopy duration, and acute/follow-up pacing parameters were recorded.
Main Results:
- DHBP was successfully achieved in 92% of patients (24 out of 26).
- Mean procedure time was 75 minutes; mean fluoroscopy time was 11 minutes.
- Acute pacing threshold was 2.3 V, and sensed potentials were 2.9 mV. At 3 months, pacing parameters remained stable, with no major complications.
Conclusions:
- DHBP is a feasible pacing method.
- A new system with a steerable catheter and active fixation lead facilitates DHBP.
- The technique demonstrated a high success rate of 92% in the studied population.
Introduction:
Much clinical evidence has shown that right ventricular (RV) apical pacing is detrimental to left ventricular function. Preservation of the use of the His-Purkinje (H-P) system may be ideal in heart block that is restricted to the AV node, but may be of no benefit when H-P disease exists.
Aim:
To investigate the feasibility of direct His-bundle pacing (DHBP) using a new system consisting of a steerable catheter and a new 4.1 F screw-in lead.
Method:
Between May and December 2004, 26 patients (19 male, mean age: 77 +/- 5 years) with a standard pacemaker (PM) indication and preserved His-bundle conduction were enrolled and DHBP was attempted.
Results:
DHBP was achieved in 24 patients (92%); two patients were paced in the His area, but the paced QRS morphology and duration were different from the native QRS. The mean time for lead positioning was 19 +/- 17 minutes, the mean fluoroscopy time was 11 +/- 8 minutes, and the total procedure time (skin-to-skin including positioning of a quadripolar diagnostic catheter for His recording) was 75 +/- 18 minutes. In DHBP pacing, the acute pacing threshold was 2.3 +/- 1.0 V at a pulse duration of 0.5 msec, and the sensed potentials were 2.9 +/- 2.0 mV. At a 3-month follow-up examination, the same QRS duration and morphology recorded on implantation were observed in all patients. The pacing threshold was 2.8 +/- 1.4 V, and sensed potentials were 2.5 +/- 1.8 mV; the sensing configuration was changed from bipolar to unipolar in 6 patients to resolve undersensing issues. No major complications were observed.
Conclusions:
This feasibility study shows that DHBP can be accomplished with a new system consisting of a steerable catheter and an active fixation lead in 92% of the patients in whom it was attempted.
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