Crossing of strength–duration curves with His bundle pacing and impact of pacing mode on thresholds

Abstract

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Troubleshooting Programming of Conduction System Pacing

“…Strength-duration curves for His bundle (HB) capture follow a similar pattern compared to those of myocardial capture, although crossing of the curves has been reported. [ 10 , 11 ] The chronaxie (point of minimal energy drain) is significantly lower in patients with selective His bundle pacing (S-HBP). Therefore, although a pulse width of 1 ms is often employed to reduce high amplitude threshold, a narrower pulse duration (0.2–0.4 ms) may save battery life in the case of short chronaxie (E = V[ 2 ]xPW/R).…”

“…It has been described that HB and myocardial thresholds can vary considerably depending upon the pacing mode (DDD or VVI) which is programmed during the threshold test. [ 11 ] Until the prevalence of this finding is determined, it is wise to perform threshold tests in the device’s permanently programmed mode.…”