Permanent His-bundle pacing using distal His-bundle electrogram-guided approach in patients with atrioventricular
Kazumasa Suga1,2, Hiroyuki Kato1, Yasuya Inden2
1Division of Cardiology, Japan Community Healthcare Organization Chukyo Hospital, Nagoya, Japan.
Insights
This study shows that targeting a distal His-bundle electrogram (HBE) during His-bundle pacing (HBP) improves success rates, especially for patients with infranodal block. This technique offers feasible and stable pacing for atrioventricular block.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Devices
Background:
- Permanent His-bundle pacing (HBP) is an effective and safe pacing strategy.
- However, HBP implantation success rates are often limited, particularly in patients with infranodal block.
- This highlights the need for improved HBP techniques.
Purpose of the Study:
- To evaluate the efficacy and feasibility of His-bundle pacing (HBP) implantation using an electrophysiological guided approach.
- The study specifically targeted a distal His-bundle electrogram (HBE) in patients diagnosed with atrioventricular block (AVB).
Main Methods:
- Thirty-four patients with AVB, including 28 with infranodal block, underwent HBP implantation.
- A unipolar mapping technique was employed to target the distal HBE, aiming to pace beyond the block site.
- His-capture thresholds were monitored for one year post-implantation.
Main Results:
- Successful HBP was achieved in 26 patients (76.5%), with 21 of 28 patients (75%) with infranodal block achieving successful pacing.
- Detection of a distal HBE was significantly more frequent in the successful HBP group (65.4%) compared to the failure group (0%, p=0.001).
- Among patients with intra-Hisian block, 93% achieved successful HBP with distal HBE detection. A higher implantation His-capture threshold and less distal HBE detection predicted future increases in threshold.
Conclusions:
- His-bundle pacing (HBP) guided by a distal His-bundle electrogram (HBE) approach appears feasible.
- This technique may lead to stable pacing outcomes in patients suffering from intra-Hisian and atrioventricular nodal block.
- Targeting distal HBE is crucial for successful HBP in challenging AVB cases.
Background:
Permanent His-bundle pacing (HBP) is effective and safe; however, the success rate of HBP is low, especially in patients with infranodal block. This study aimed to assess the efficacy and feasibility of HBP implantation using an electrophysiological guided approach targeting a distal His-bundle electrogram (HBE) in patients with atrioventricular block (AVB).
Methods:
Thirty-four consecutive patients with AVB (infranodal block in 28 patients) who underwent HBP were enrolled. During implantation, we attempted to target the distal part of the HBE (distal HBE) beyond the block site based on unipolar mapping. The His-capture threshold was evaluated for 1 year after implantation.
Results:
HBP was achieved in 26 patients and in 21 patients (75%) with infranodal block. Detection of distal HBE was significantly higher in the successful HBP group than in the HBP failure group (65.4% vs. 0%, p = .001). Among 15 patients with intra-Hisian block, 14 patients (93%) successfully achieved HBP with distal HBE detection. During the 1-year follow-up period, an increase in His-capture threshold by ≥1.0 V at 1.0 ms occurred in five (19.2%) of 26 patients. The increased His-capture threshold group exhibited significantly less detection of distal HBE (20% vs. 76.2%; odds ratio 0.078, 95% confidence interval 0.07-0.87, p = .038) and a higher His-capture threshold at implantation (2.0 ± 1.1 V vs. 1.1 ± 0.9 V; odds ratio 1.702, 95% confidence interval 1.025-2.825, p = 0.04) than the non-increased His-capture threshold group.
Conclusion:
HBP implantation guided by distal HBE approach may be feasible with subsequent stable pacing in patients with intra-Hisian and atrioventricular nodal block.
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