Permanent His-bundle pacing using stylet-directed, active-fixation leads placed via coronary sinus sheaths compared...

Area of Science:

• Cardiology
• Electrophysiology
• Medical Devices

Background:

• His-bundle pacing (HBP) traditionally uses stylet-less leads via custom catheters.
• The use of coronary sinus (CS) sheaths for delivering stylet-driven leads (SDLs) in HBP has not been previously described.

Purpose of the Study:

• To evaluate the feasibility and performance of HBP using SDLs delivered through CS sheaths.
• To compare this novel approach with the conventional method using stylet-less leads.

Main Methods:

• Delivery of Medtronic 4471 and 7742 SDLs was attempted in 27 patients using CS guide catheters and custom stylets.
• Procedural characteristics and lead performance were compared to 17 patients who received lumen-less leads (LLLs).
• Patients had diverse pacing indications.

Main Results:

• Successful HBP was achieved in 89% of patients with SDLs versus 88% with LLLs.
• Procedural and fluoroscopy times were similar between groups (P=NS).
• Acute HBP thresholds were higher with SDLs (2.6 ± 1.5 V vs 1.5 ± 1.2 V; P=.02), remaining stable at follow-up.

Conclusions:

• Permanent HBP with SDLs delivered via conventional CS sheaths is feasible.
• Procedural characteristics and lead performance are clinically acceptable.
• This technique provides a viable alternative for HBP.