A Novel Pacing Strategy With Low and Stable Output: Pacing the Left Bundle Branch Immediately Beyond the Conduction Block

Huang, Weijian; Su, Lan; Wu, Shengjie; Xu, Lei; Xiao, Fangyi; Zhou, Xiaohong; Ellenbogen, Kenneth A.

doi:10.1016/j.cjca.2017.09.013

Cited by 572 publications

(584 citation statements)

References 4 publications

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“…In fact, since biventricular pacing was the previous such pacing revolution, it is notable that after a decade of experience major RCTs were reporting success rates (83% in PAVE and 82% in RD‐CHF) similar to the HBP success rates in this study. Importantly, HBP leads and delivery equipment can also be used for conventional atrial or ventricular pacing and even distal conduction system pacing where the left bundle itself is directly stimulated, offering flexibility when HBP capture cannot be achieved …”

Section: Discussionsupporting

confidence: 79%

His bundle pacing, learning curve, procedure characteristics, safety, and feasibility: Insights from a large international observational study

Keene

Arnold

Jastrzębski

et al. 2019

Cardiovasc electrophysiol

145

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Background His‐bundle pacing (HBP) provides physiological ventricular activation. Observational studies have demonstrated the techniques’ feasibility; however, data have come from a limited number of centers. Objectives We set out to explore the contemporary global practice in HBP focusing on the learning curve, procedural characteristics, and outcomes. Methods This is a retrospective, multicenter observational study of patients undergoing attempted HBP at seven centers. Pacing indication, fluoroscopy time, HBP thresholds, and lead reintervention and deactivation rates were recorded. Where centers had systematically recorded implant success rates from the outset, these were collated. Results A total of 529 patients underwent attempted HBP during the study period (2014‐19) with a mean follow‐up of 217 ± 303 days. Most implants were for bradycardia indications. In the three centers with the systematic collation of all attempts, the overall implant success rate was 81%, which improved to 87% after completion of 40 cases. All seven centers reported data on successful implants. The mean fluoroscopy time was 11.7 ± 12.0 minutes, the His‐bundle capture threshold at implant was 1.4 ± 0.9 V at 0.8 ± 0.3 ms, and it was 1.3 ± 1.2 V at 0.9 ± 0.2 ms at last device check. HBP lead reintervention or deactivation (for lead displacement or rise in threshold) occurred in 7.5% of successful implants. There was evidence of a learning curve: fluoroscopy time and HBP capture threshold reduced with greater experience, plateauing after approximately 30‐50 cases. Conclusion We found that it is feasible to establish a successful HBP program, using the currently available implantation tools. For physicians who are experienced at pacemaker implantation, the steepest part of the learning curve appears to be over the first 30‐50 cases.

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Section: Discussionsupporting

confidence: 79%

His bundle pacing, learning curve, procedure characteristics, safety, and feasibility: Insights from a large international observational study

Keene

Arnold

Jastrzębski

et al. 2019

Cardiovasc electrophysiol

145

View full text Add to dashboard Cite

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“…Compared with previous studies in which high pacing output was needed to correct LBBB,4 6 16 17 we found in 21.4% studied patients that HBP at the capture threshold could correct LBBB with a low pacing threshold, likely because the pacing site is near or beyond the region of block, as we reported previously 22. This finding is important for reducing the risk of exit block due to progression of distal conduction system disease and allowed us to use low pacing outputs to restore His–Purkinje conduction.…”

Section: Discussioncontrasting

confidence: 55%

Long-term outcomes of His bundle pacing in patients with heart failure with left bundle branch block

Huang

et al. 2018

Heart

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“…However HBP in these patients may be associated with high pacing thresholds to capture the distal His bundle and/or correct LBBB. Recently several groups have shown the feasibility of left bundle branch area pacing (LBBP) in patients with atrioventricular block and/or LBBB . In this report, we present the utility of 3D mapping technique to achieve LBBP.…”

Section: Introductionmentioning

confidence: 96%

Left bundle branch pacing utilizing three dimensional mapping

Vijayaraman

Panikkath

Mascarenhas

et al. 2019

Cardiovasc electrophysiol

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Introduction Permanent His bundle pacing is feasible and effective in patients with atrioventricular block or left bundle branch block. However, pacing thresholds to capture the distal His bundle is often higher. Recently left bundle branch area pacing (LBBP) has been shown to be feasible by advancing the lead transvenously, deep into the interventricular septum to reach the left ventricular endocardial surface. In this article we describe the utility of three dimensional (3D) mapping to achieve LBBP. Methods Ensite Precision (Abbott) mapping system was used to perform LBBP. A decapolar catheter was used to create 3D map of right atrium and right ventricle (RV). Regions of interest (His bundle, potential LBBP sites of interest in RV) were tagged in the 3D map. The LBBP lead was implanted utilizing the 3D map. The lead depth in the septum was assessed in the 3D map. Results LBBP was performed in three patients: chronic LBBB and intermittent 2:1 atrioventricular block; atrioventricular (AV) node ablation and conduction system pacing; and bifascicular block and intermittent AV block in a patient with severe left ventricular hypertrophy. LBBP was successful in all three patients. The lead depth in the interventricular septum was 12, 11, and 21 mm, respectively as assessed by 3D mapping. Conclusions Three‐dimensional mapping was helpful in achieving LBBP in patients with LBBB, severe left ventricular hypertrophy or during AV node ablation. 3D mapping also facilitated easy assessment of lead depth during and after lead fixation. 3D mapping techniques may be a valuable tool to reduce the learning curve of implanters with minimal experience in LBBP.

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A Novel Pacing Strategy With Low and Stable Output: Pacing the Left Bundle Branch Immediately Beyond the Conduction Block

Cited by 572 publications

References 4 publications

His bundle pacing, learning curve, procedure characteristics, safety, and feasibility: Insights from a large international observational study

His bundle pacing, learning curve, procedure characteristics, safety, and feasibility: Insights from a large international observational study

Long-term outcomes of His bundle pacing in patients with heart failure with left bundle branch block

Left bundle branch pacing utilizing three dimensional mapping

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