Permanent His-bundle pacing using distal His-bundle electrogram-guided approach in patients with atrioventricular...

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.