Autopsy evaluation of the implantation site of a His bundle pacing lead demonstrating selective capture
Hiroyuki Kato1, Osamu Igawa2, Kazumasa Suga3
1Division of Cardiology, Japan Community Health Care Organization Chukyo Hospital, Nagoya, Japan.
Insights
Autopsy revealed His bundle pacing lead placement through the tricuspid valve, causing a prolonged interval. Transthyretin amyloidosis may impact pacing effectiveness in elderly patients.
Area of Science:
- Cardiovascular Medicine
- Electrophysiology
- Cardiac Pathology
Background:
- His bundle pacing (HBP) is an advanced technique for heart rhythm management.
- Autopsy evaluations of HBP lead placement are infrequent, limiting understanding of long-term lead behavior.
- Atrioventricular block and heart failure are common indications for pacing in elderly individuals.
Observation:
- A 98-year-old male patient underwent HBP implantation for atrioventricular block and heart failure.
- Post-implantation, selective HBP was achieved, but with a prolonged stimulus-to-QRS interval.
- Autopsy revealed the HBP lead positioned ventrally, traversing the anteroseptal commissure of the tricuspid valve.
Findings:
- Macroscopic examination confirmed unusual lead placement, potentially explaining the extended stimulus-to-QRS duration.
- The lead's passage through the tricuspid valve commissure may have affected conduction.
- The patient's transthyretin cardiac amyloidosis could have contributed to distal conduction system abnormalities.
Implications:
- This case highlights the importance of detailed autopsy in understanding HBP lead positioning and its impact on pacing parameters.
- Transthyretin cardiac amyloidosis presents a potential challenge for achieving optimal His bundle pacing outcomes.
- Further research is needed to correlate lead placement variations with clinical outcomes and cardiac pathology in HBP patients.
Abstract:
Evaluations of His bundle pacing (HBP) lead location at autopsy examination have been rarely reported. We report an autopsy case of a 98-year-old man who underwent HBP implantation due to atrioventricular block and heart failure. Although selective HBP was achieved with an acceptable threshold, the stimulus-to-QRS interval was relatively longer without correction of the right bundle-branch block. A macroscopic examination revealed that the HBP lead was inserted on the ventricular side passing through the anteroseptal commissure of the tricuspid valve. Transthyretin cardiac amyloidosis may affect the distal conduction system resulting in a long stimulus-to-QRS interval during selective HBP.
