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

Area of Science:

• Cardiology
• Electrophysiology
• Medical Devices

Background:

• His bundle pacing (HBP) is the most physiological pacing method.
• Standard fluoroscopic techniques for HBP can be challenging and time-consuming.
• Reducing fluoroscopy time and radiation dose is crucial for patient and operator safety.

Purpose of the Study:

• To evaluate the feasibility, efficacy, and safety of electrogram (EGM)-guided HBP with minimal or no fluoroscopy.
• To assess acute and 30-day outcomes of this novel pacing technique.

Main Methods:

• A prospective study involving 41 consecutive patients undergoing EGM-guided HBP.
• Lead implantation guided exclusively by electrical signals, with minimal fluoroscopy used only when necessary.
• Comparison of fluoroscopy time, procedural time, and outcomes between selective and non-selective HBP.

Main Results:

• Successful HBP was achieved in 95% of patients (39/41).
• The His bundle lead position was achieved without fluoroscopy in 79.4% of patients.
• Minimal fluoroscopy (mean 8 seconds) was required in only 8 patients.
• No significant differences in fluoroscopy time or procedural parameters were observed between selective and non-selective HBP.
• One patient (2.6%) experienced lead dislodgement one day post-procedure.

Conclusions:

• EGM-guided HBP is a safe and efficient method for achieving physiological pacing.
• This technique allows for minimal or no fluoroscopy, reducing radiation exposure.
• Fluoroscopy was primarily needed for sheath removal and atrial lead placement.