Intermediate-term performance and safety of His-bundle pacing leads: A single-center experience
Todd Teigeler1, Jeffrey Kolominsky2, Chau Vo3
1Division of Cardiac Electrophysiology, Virginia Commonwealth University, Richmond, Virginia.
Insights
His-bundle pacing (HBP) shows promising results but requires further investigation due to increased capture thresholds and lead revision rates at intermediate follow-up. Longer-term data are needed to fully assess its safety and efficacy.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Device Performance
Background:
- Short-term data on His-bundle pacing (HBP) safety and feasibility exist.
- Longer-term performance of HBP leads beyond one year remains largely uncharacterized.
Purpose of the Study:
- To evaluate the intermediate-term safety and performance of His-bundle pacing (HBP) leads.
- To identify potential complications and changes in pacing parameters over time.
Main Methods:
- Retrospective analysis of all His-bundle pacing (HBP) lead implants at a single center from January 2014 to January 2019.
- Utilized Medtronic SelectSecure 3830-69 cm pacing leads for HBP implantation.
- Assessed implantation success rates, patient demographics, pacing indications, and follow-up parameters including capture thresholds and lead revisions.
Main Results:
- Successful HBP implantation achieved in 93% of 295 attempts, with a mean follow-up of 22.8 months.
- Mean HBP capture threshold significantly increased from 1.1 V at implant to 1.7 V at follow-up (P <.001), with 24% of patients having thresholds ≥2.5 V.
- 17% experienced loss of His-bundle capture, and 11% required lead revisions, primarily due to high thresholds.
Conclusions:
- While HBP may prevent pacing-induced cardiomyopathy, elevated capture thresholds and lead revision rates are concerning.
- Intermediate-term follow-up reveals significant changes in HBP lead performance.
- Further multi-center, longer-term studies are essential to fully understand HBP lead performance and safety.
Background:
The short-term safety, feasibility, and performance of His-bundle pacing (HBP) leads have been reported; however, their longer-term performance beyond 1 year remains unclear.
Objective:
The purpose of this study was to examine the intermediate-term performance and safety of HBP.
Methods:
All HBP lead implants at Virginia Commonwealth University between January 2014 and January 2019 were analyzed. HBP was performed using a Medtronic SelectSecure 3830-69 cm pacing lead.
Results:
Of 295 attempts, successful HBP implantation (selective or nonselective) was seen in 274 cases (93%). Mean follow-up duration was 22.8 ± 19.5 months (median 19.5; interquartile range 11-33). Mean age was 69 ± 15 years; 58% were males; and ejection fraction <50% was noted in 30%. Indications for pacemaker included sick sinus syndrome in 41%, atrioventricular block in 36%, cardiac resynchronization therapy in 7%, and refractory atrial fibrillation in 15%. Selective HBP was achieved in 33%. Mean HBP capture threshold at implant was 1.1 ± 0.9 V at 0.8 ± 0.2 ms, which significantly increased at chronic follow-up to 1.7 ± 1.1 V at 0.8 ± 0.3 ms (P <.001). Threshold was ≥2.5 V in 24% of patients, and 28% had an increase in HBP threshold ≥1 V. Loss of His-bundle capture at follow-up (septal right ventricular pacing) was seen in 17%. There was a total of 31 (11%) lead revisions, primarily for unacceptably high thresholds.
Conclusion:
Although HBP can prevent or improve pacing-induced cardiomyopathy, the elevated capture thresholds, loss of His-bundle capture, and lead revision rates at intermediate follow-up are of concern. Longer-term follow-up data from multiple centers are needed.
