Direct His bundle and paraHisian cardiac pacing.

Area of Science:

• Electrophysiology
• Cardiology
• Medical Devices

Background:

• Direct His bundle pacing (DHBP) and paraHisian pacing have seen improved success rates due to new fixation systems.
• DHBP presents challenges including complexity, higher pacing thresholds, and reduced device longevity.
• ParaHisian pacing, a fusion of myocardial and His bundle capture, offers simpler implementation and better electrical parameters.

Purpose of the Study:

• To compare the efficacy and implementation of direct His bundle pacing (DHBP) versus paraHisian pacing.
• To evaluate the impact of these pacing methods on procedural parameters and device longevity.
• To explore the potential of DHBP in cardiac resynchronization therapy.

Main Methods:

• Review of procedural outcomes and electrical parameters for DHBP and paraHisian pacing.
• Analysis of lead placement strategies, including the use of safety leads.
• Assessment of patient populations suitable for these pacing techniques, including those with AV block and bundle branch block.

Main Results:

• ParaHisian pacing demonstrates easier implementation and superior electrical parameters over DHBP.
• Dedicated fixation systems have reduced procedural duration, dislodgement rates, and fluoroscopy time for both techniques.
• ParaHisian pacing may obviate the need for a safety lead due to reliable long-term myocardial capture.

Conclusions:

• A clinical shift towards paraHisian pacing is occurring due to its advantages over DHBP.
• Both DHBP and paraHisian pacing are achievable in a significant number of patients with various forms of AV block.
• DHBP may have a role in cardiac resynchronization for specific patient subsets with intraHisian conduction disease.