Closed loop stimulation with His bundle lead placement.
Leonardo Marinaccio1, Daniele Giacopelli2,3, Giuliana Ginocchio1
1Department of Cardiology, Immacolata Concezione Hospital, Piove di Sacco, PD, Italy.
Journal of Cardiology Cases
|August 11, 2022
Summary
Closed-loop stimulation (CLS) effectively managed heart rate in a patient with His bundle pacing and atrial fibrillation. This rate-responsive algorithm shows promise for physiological pacing in similar conditions.
Area of Science:
- Cardiology
- Biomedical Engineering
- Electrophysiology
Background:
- Closed-loop stimulation (CLS) is a rate-responsive pacing algorithm analyzing intracardiac impedance.
- Its efficacy with His bundle (HB) lead placement, compared to the right ventricle, is not well-established due to potential contractility differences.
- Atrial fibrillation with chronotropic incompetence presents challenges for heart rate management.
Observation:
- CLS was evaluated in a patient with brady atrial fibrillation undergoing permanent His bundle pacing.
- The patient underwent various physiological and mental stress tests (hand-grip, mental, bicycle exercise).
Findings:
- The CLS algorithm demonstrated appropriate heart rate responses to both mental and physical exertion.
- The system successfully adapted pacing in response to the patient's activity levels.
Implications:
- Permanent His bundle pacing combined with CLS may offer a physiological pacing solution for atrial fibrillation patients with chronotropic incompetence.
- This approach could improve quality of life by providing more natural heart rate regulation.
- Further studies are warranted to confirm these findings in a larger patient cohort.
