Electrogram‐only guided approach to His bundle pacing with minimal fluoroscopy: A single‐center experience

Abstract

Introduction His bundle pacing (HBP) is the most physiological pacing. The standard technique based on fluoroscopic approach might be challenging and fluoro consuming. Targeting the His guided exclusively by the electrical signals could enable a precise lead implant, thus reducing fluoroscopy time (FT) and X‐ray dose, desirable both for patients and operators. The aim of the study is to evaluate the feasibility, efficacy, and safety both acutely and at 30 days of the electrogram (EGM)‐guided HBP with minimal or no fluoroscopy. Methods and Results Between October and December 2018, 41 consecutive patients underwent EGM‐guided HBP. Successful HBP was obtained in 39 (95%) patients, (30 males, 78 ± 10 years). Selective HBP (S‐HBP) was achieved in 23 (59%), nonselective HBP (NS‐HBP) in 16 (41%) patients. The final HBP lead position was reached in 31 (79.4%) patients without fluoroscopy, only guided by electrical signals. In eight patients a minimal fluoroscopy (mean, 8 seconds) has been required. The sheath's cutting and the slack of the lead were routinely performed under fluoroscopy. No difference was observed in FT for HBP lead placement in S‐HBP and NS‐HBP (mean, 8.1 ± 25 vs 7.5 ± 20 seconds, P = .8; median value 0 vs 0 seconds). No differences were observed in FT for the entire procedure, total dose area product and total procedural time in S‐HBP and NS‐HBP. Lead dislodgement occurred in one (2.6%) patient 1 day after the procedure. Conclusions HBP could be performed safely and efficiently using the EGMs, with minimal or no fluoroscopy. Fluoroscopy was required during sheath removal and atrial lead placement.

His–Purkinje Conduction System Pacing: State of the Art in 2020

“…[ 55 , 56 ] Alternately, an EGM-only guided approach to successful HBP with minimal fluoroscopy was recently reported by Zanon et al to be compatible with use of the SelectSecure 3830 lead. [ 57 ] Automated analysis of HBP ECGs is in development and this has the potential to facilitate even more rapid uptake of the technique. [ 24 ] Meanwhile, new evidence is gathering regarding the relative efficacy of LBBP compared with HBP, and its ECG characteristics are being more rigorously codified.…”

How to Implant His Bundle and Left Bundle Pacing Leads: Tips and Pearls

“…Zanon et al demonstrated that HBP can be performed primarily using an electrogram with zero or minimal fluoroscopy with high success rates. [ 12 ] In that study, the sheath, along with the lead, was advanced gently with counterclockwise and clockwise rotation into the right atrium through a standard 7 Fr introducer. The pacing lead was then connected to the alligator cable in a unipolar fashion.…”

“…Further anticlockwise rotation helped reach the HB area. [ 12 ] Gentle manipulation of the system helped record a clear near-field His potential from the pacing lead. Unipolar threshold measurement was performed at a pulse width of 1 ms before fixing the lead in the membranous septum.…”

Simple approaches to reduce radiation in the electrophysiology laboratory replay

“…We appreciate the letter from Serkan Cay 1 and colleagues entitled "Simple Approaches to Reduce Radiation in the Electrophysiology Laboratory." 2 We agree with Serkan and colleagues that fluoroscopy time per se is not enough and that dose area product, air kerma, frame rate, and various autoregulated variables are more important data. We completely agree with the observation regarding the physics of the dose radiation and are very grateful to our colleagues for their accurate explanation and involvement in the field.…”