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His bundle electrogram recording using a multipolar electrode catheter via the arm veins
Insights
This study demonstrates that the arm vein approach is a viable alternative for His bundle electrograms, offering practical advantages for atrial pacing and His bundle recording. This method provides stable recordings and is useful when the femoral approach is not feasible.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Devices
Background:
- Atrioventricular conduction disturbances require accurate His bundle electrograms for diagnosis and management.
- The standard femoral approach for His bundle electrograms may not always be feasible.
Purpose of the Study:
- To evaluate the efficacy and advantages of an arm vein approach for His bundle electrograms.
- To assess the utility of a hexapolar electrode catheter in this approach.
Main Methods:
- His bundle electrograms were performed in 18 patients using a 6F hexapolar electrode catheter inserted via the arm vein.
- The catheter was positioned in a "golf club" shape across the tricuspid valve for atrial pacing and His bundle recording.
Main Results:
- Successful His bundle electrograms were obtained in all 18 patients.
- The arm approach proved to be a feasible alternative to the femoral route.
- The hexapolar catheter facilitated both atrial pacing and His bundle recordings.
Conclusions:
- The arm vein approach is a practical and effective alternative for His bundle electrogram studies.
- Hexapolar catheters offer advantages for simultaneous pacing and recording, enabling stable, long-term monitoring.
- This technique may be particularly useful for His bundle electrogram studies during supine exercise.
Abstract:
In eighteen patients with atrioventricular conduction disturbance, His bundle electrograms were studied via the arm vein. A 6F Berkovits-Castellanos USCI hexapolar electrode catheter was introduced into the right atrium and looped across the tricuspid valve in a "golf club" shape. The main aim was to leave the two distal electrodes in contact with the atrial endocardium to perform atrial pacing, while displaying the other four electrodes along the superior angle of the tricuspid valve for proximal and distal His bundle recordings. His bundle electrograms were successfully obtained in all cases. The arm approach provides an alternate route whenever the femoral approach is not feasible. Moreover, the use of an hexapolar electrode catheter provides some practical advantages: 1) it enables atrial pacing to be performed, as well as proximal and distal His bundle recording to be obtained, by using the same multipolar electrode catheter; and 2) it allows long-term monitoring of His bundle potentials, in view of the stability of His bundle recordings. Finally, the arm approach could be the method of choice for the study of His bundle electrograms during leg supine exercise in selected patients.