Electrical and Mechanical Cardiac Resynchronisation by Novel Direct His-bundle Pacing in a Heart Failure Patient

Manovel, Ana; Barba-Pichardo, Rafael; Tobaruela, A

doi:10.1016/j.hlc.2011.05.617

Cited by 19 publications

(6 citation statements)

References 6 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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“…Hyper-response, typically described as a patient showing functional recovery and left ventricular ejection fraction (LVEF) ≥50%, has been reported with CRT 5 , 6 and similar recovery has been seen with HBP, after restoration of normal intrinsic conduction. 7 , 8 , 9 In the latter 3 patients, there was normalization of ventricular activation with HBP, and QRS durations ranged from 80 to 100 ms in these patients.…”

Section: Introductionmentioning

confidence: 90%

Hyper-response to cardiac resynchronization with permanent His bundle pacing: Is parahisian pacing sufficient?

Ajijola

Romero

Vorobiof

et al. 2015

HeartRhythm Case Reports

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“…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, LV ejection fraction increased from 28 to 50%, and mitral regurgitation was reduced from ++++ to ++. Manovel et al 25 reported a similar case involving a 62‐year‐old man with a dilated cardiomyopathy and NYHA class III heart failure (LV ejection fraction 30%) and complete LBBB (150 ms). DHBP was performed and the LBBB disappeared.…”

Section: Hemodynamicsmentioning

confidence: 96%

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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Electrical and Mechanical Cardiac Resynchronisation by Novel Direct His-bundle Pacing in a Heart Failure Patient

Cited by 19 publications

References 6 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

Hyper-response to cardiac resynchronization with permanent His bundle pacing: Is parahisian pacing sufficient?

Direct His Bundle and Parahisian Cardiac Pacing

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