Cardiac Resynchronization Through Selective His Bundle Pacing in a Patient with the So‐Called InfraHis Atrioventricular Block

Moriña‐Vázquez, Pablo; Barba-Pichardo, Rafael; Venegas‐Gamero, José; Herrera-Carranza, Manuel

doi:10.1111/j.1540-8159.2005.00150.x

Cited by 37 publications

(18 citation statements)

References 9 publications

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“…[10][11][12][13][14] Moreover, patients with a pacemaker indication have shown improved clinical response and greater 5-year survival with PHBP compared to right ventricular (RV) pacing. 15 In patients with heart failure and LBBB, PHBP has been shown to achieve cardiac resynchronization therapy (CRT), 11,[16][17][18][19][20][21] and some investigators have suggested PHBP as first-line therapy. 21,22 Detailed how-to publications 8,9,23 and a recent guidance publication have further contributed to adoption of PHBP use.…”

Section: Introductionmentioning

confidence: 99%

Permanent His-bundle pacing using stylet-directed, active-fixation leads placed via coronary sinus sheaths compared to conventional lumen-less system

et al. 2019

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BACKGROUND The use of coronary sinus (CS) sheaths to deliver stylet-driven leads (SDLs) for His-bundle pacing (HBP) has not been described. Conventionally, HBP is achieved using a styletless lead delivered through a customized catheter. OBJECTIVE The purpose of this study was to characterize the acute and early-term HBP experience with stylet-driven, active-fixation leads delivered through CS sheaths compared to the conventional approach. METHODS Delivery of Medtronic 4471 and 7742 SDLs was attempted in 27 patients. Delivery was facilitated using CS guide catheters and custom-shaped stylets. Procedural characteristics and lead performance were compared to those of a group of 17 patients in whom delivery of 3830 lumen-less leads (LLLs) was attempted. Patients had heterogeneous pacing indications. RESULTS HBP with SDL was successful in 24 of 27 patients(89%) compared to 15 of 17 patients (88%) in the LLL group. Mean procedural and fluoroscopy times in the SDL and LLL groups were 129 6 43 minutes vs 104 6 43 minutes and 9.6 6 5.2 minutes vs 8.3 6 5.0 minutes, respectively (both P 5 NS). There was a significant difference in procedure and fluoroscopy times within the SDL group between the first and second halves of the series, probably secondary to a learning curve. Acute HBP thresholds were higher with SDL than with LLL (2.6 6 1.5 V vs 1.5 6 1.2 V; P 5 .02) and remained stable at 8.4 6 5.3 months. Both SDLs exhibited similar pacing thresholds. Two crossovers between groups occurred (1 in each group). Four patients with SDL and 1 patient with LLL exhibited high thresholds during follow-up. CONCLUSION Permanent HBP using stylet-driven, active-fixation leads delivered through conventional CS sheaths is feasible. Procedural characteristics and lead performance were clinically acceptable.

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Section: Introductionmentioning

confidence: 99%

Permanent His-bundle pacing using stylet-directed, active-fixation leads placed via coronary sinus sheaths compared to conventional lumen-less system

et al. 2019

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“…PRT pacing of the HB by reversing physiological conduction in a patient with CHF and LBBB seems to be an alternative to CRT 10 . One may speculate that there is a considerable number of patients with CHF and LBBB suitable for PRT.…”

Section: Discussionmentioning

confidence: 99%

“…1 PRT pacing of the HB by reversing physiological conduction in a patient with CHF and LBBB seems to be an alternative to CRT. 10 One may speculate that there is a considerable number of patients with CHF and LBBB suitable for PRT. If we identify such patients it may offer an opportunity to improve the results of pacing treatment in CHF; however, this requires further investigation.…”

Section: Discussionmentioning

confidence: 99%

Physiologic Resynchronization Therapy: A Case of His Bundle Pacing Reversing Physiologic Conduction in a Patient with CHF and LBBB During 2 Years of Observation

Dąbrowski

Kleinrok

Koźluk

et al. 2010

Journal of Cardiovascular Electrophysiology

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This is a case of a patient with congestive heart failure and left bundle branch block who was referred for cardiac resynchronization therapy implantation. Instead, a His bundle pacing was achieved with a narrow QRS complex. During 27 months of observation, the patient improved dramatically from NYHA class IV to I. Echo parameters improved significantly the LV diameter from 75/50 to 60/40 mm, EF from 28 to 50%, and mitral regurgitation from 4 to 2°.

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“…8 DHBP and paraHisian pacing can be used only in patients with an intact distal conduction system with the understanding that it carries the risk of an unpredictable gradual progression of conduction disturbances distal to the pacing site. DBHP and paraHisian pacing can be achieved in a substantial proportion of patients with varying grades of AV block 28, 29 (some after AV junctional ablation 7, 16, 30, 31 ) and a narrow QRS complex and in some patients with bundle branch block caused by an intraHisian lesion. However, paraHisian pacing is generally preferred in patients with AV block because it is easier to achieve.…”

Section: Overviewmentioning

confidence: 99%

Direct His Bundle and Parahisian Cardiac Pacing

Zanon¹,

Barold²

2012

Noninvasive Electrocardiol

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The success rate of direct His bundle pacing (DHBP) and paraHisian pacing has improved remarkably in the last 3-5 years with the advent of dedicated fixation systems that have reduced procedural duration, dislodgement rate, and fluoroscopy time. The methodology of DBHP remains still more complex than paraHisian pacing and is associated with high-pacing thresholds. Thus, DHBP entails greater battery current drain and reduced device longevity. A shift toward paraHisian pacing (which is fusion pacing of myocardium and His bundle) has occurred because its implementation is easier and the electrical parameters are superior to those of DBHP. Currently, an additional safety lead is inserted at the RV apex or outflow tract to prevent asystole, especially in patients with pure DHBP. It is often possible to avoid a safety lead with paraHisian pacing because ventricular pacing is virtually assured on a long-term basis via myocardial capture. DBHP and paraHisian pacing can be achieved in a substantial proportion of patients with varying grades of narrow QRS AV block or after AV junctional ablation and in some patients with the ECG manifestation of bundle branch block caused by an intraHisian lesion. Preliminary observations suggest that DHBP may be useful in some patients requiring cardiac resynchronization if it produces a narrow QRS complex because the site of an intraHisian lesion responsible for left bundle branch block is above the site of DHBP.

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Cardiac Resynchronization Through Selective His Bundle Pacing in a Patient with the So‐Called InfraHis Atrioventricular Block

Cited by 37 publications

References 9 publications

Permanent His-bundle pacing using stylet-directed, active-fixation leads placed via coronary sinus sheaths compared to conventional lumen-less system

Permanent His-bundle pacing using stylet-directed, active-fixation leads placed via coronary sinus sheaths compared to conventional lumen-less system

Physiologic Resynchronization Therapy: A Case of His Bundle Pacing Reversing Physiologic Conduction in a Patient with CHF and LBBB During 2 Years of Observation

Direct His Bundle and Parahisian Cardiac Pacing

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