Safety of Distal His Bundle Pacing Via the Right Ventricle Backed Up by Adjacent Ventricular Capture
Toshiaki Sato1, Kyoko Soejima2, Akiko Maeda2
1Division of Advanced Arrhythmia Management, Kyorin University School of Medicine, Mitaka, Japan.
Insights
Distal His bundle pacing (HBP) via the right ventricle offers superior local ventricular thresholds compared to proximal HBP. This finding is crucial for maintaining capture and preventing lead issues in bradycardia patients.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Devices
Background:
- His bundle pacing (HBP) preserves physiological ventricular activation.
- The long-term capture threshold of the adjacent ventricle in HBP has not been thoroughly evaluated.
- Understanding pacing and sensing parameters is crucial for optimizing HBP lead placement.
Purpose of the Study:
- To compare distal His bundle pacing (HBP) via the right ventricle with proximal HBP via the right atrium.
- To investigate differences in pacing and sensing parameters between these two HBP approaches.
- To evaluate the long-term effectiveness and safety of distal versus proximal HBP.
Main Methods:
- Fifty patients with bradycardia underwent HBP (25 distal, 25 proximal).
- Lead tip locations were confirmed using echocardiography.
- Pacing and sensing parameters were monitored for 1 year post-implantation.
Main Results:
- Distal HBP showed markedly lower local ventricular thresholds than proximal HBP.
- No significant difference was observed in distal HBP vs. proximal HBP thresholds.
- Optimal implantation values for predicting 6-month capture threshold were identified (ventricular electrogram amplitude ≥2.0 mV, capture threshold ≤1.1 V).
- Atrial oversensing was frequent with proximal HBP but absent with distal HBP.
Conclusions:
- Distal HBP via the right ventricle provides superior local ventricular thresholds compared to proximal HBP.
- Anatomy and electrophysiological properties at implantation are critical for maintaining ventricular capture.
- Distal HBP may reduce the need for lead revision due to better ventricular capture maintenance.
Objectives:
This study investigated the differences between distal His bundle pacing (HBP) via the right ventricle and proximal HBP via the right atrium with regard to pacing and sensing parameters.
Background:
HBP preserves physiological ventricular activation. The capture threshold of the adjacent ventricle accompanying HBP has not been evaluated after implantation.
Methods:
Fifty patients with bradycardia (58% with atrioventricular block) underwent successful HBP and were followed for 1 year. Precise locations of the lead tips were confirmed using follow-up echocardiography.
Results:
HBP leads were fixed via the right atrium or right ventricle (25 patients each). Overall, the local ventricle and HBP thresholds were elevated during follow-up. The distal HBP thresholds did not significantly differ from the proximal HBP thresholds, although local ventricular thresholds of distal HBP were markedly lower than those of proximal HBP. At 6 months, the accepted ventricular threshold (≤2.5 V) was maintained in 39 patients (78%). An amplitude of ventricular electrogram post-fixation of ≥2.0 mV and a capture threshold of ≤1.1 V at implantation were determined to be optimal values for predicting the accepted threshold at 6 months, with areas under the curve of 0.86 and 0.84, respectively. Atrial oversensing was often detected in proximal HBP but not distal HBP.
Conclusions:
Distal HBP via the right ventricle captured the His bundle, similar to proximal HBP via the right atrium, with a superior local ventricular threshold during follow-up. Anatomy and electrophysiological ventricular properties at implantation may be critical for maintaining adjacent ventricle capture to prevent lead revision (Evaluation of Electrophysiological Parameters related to His Bundle Pacing in Patients With Bradyarrhythmias; UMIN000031364).
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