His‐bundle pacing as a standard approach in patients with permanent atrial fibrillation and bradycardia

Jastrzębski, Marek; Moskal, P.; Bednarek, Agnieszka; Kiełbasa, Grzegorz; Czarnecka, Danuta

doi:10.1111/pace.13490

Cited by 31 publications

(28 citation statements)

References 16 publications

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“…The HBP pioneers encountered several challenges during the early years of HBP, such as low procedural success rates and high and rising thresholds . However, with the arrival of specialized delivery equipment and a more suitable pacing lead, the published HBP success rates appear to have improved . This published experience includes relatively small numbers of patients from a limited number of expert centers.…”

Section: Introductionsupporting

confidence: 65%

“…1 However, with the arrival of specialized delivery equipment and a more suitable pacing lead, the published HBP success rates appear to have improved. [4][5][6] This published experience includes relatively small numbers of patients from a limited number of expert centers. As a result, there have been concerns about whether, with current technology, it is feasible for HBP to be adopted more widely.…”

Section: Introductionmentioning

confidence: 99%

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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

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144

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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: Introductionsupporting

confidence: 65%

Section: Introductionmentioning

confidence: 99%

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

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144

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“…The current study shows that there is an increasing percentage of patients with selective HB pacing when shorter pulse widths are programmed ( Figure 4). Of note, in our center we observed a higher percentage of patients with chronic selective HB pacing (59%) 10…”

Section: Strength-duration Curves and Chronaxie Values For Rv And Hbmentioning

confidence: 52%

“…Permanent His bundle (HB) pacing offers most physiological spread of depolarization during ventricular pacing. It is free from many of the known detrimental effects of conventional right ventricular (RV) pacing, and might reverse the clinical course and structural changes induced by RV pacing and bundle branch blocks [1][2][3][4][5] With the growing amount of patients with permanent HB pacing devices [6][7][8][9][10][11] determination of basics of this form of pacing like chronaxie, rheobase and strength-duration curves, seems very important.…”

Section: Introductionmentioning

confidence: 99%

His bundle has shorter chronaxie than adjacent ventricular myocardium: Implications for pacemaker programming

Jastrzębski

Moskal

Bednarek

et al. 2019

Preprint

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Background: Strength-duration curves for permanent His bundle (HB) pacing are potentially important for pacemaker programming.Objective: We aimed to calculate strength-duration curve and chronaxie of the His bundle (HB) and of the adjacent right ventricular (RV) working myocardium and to analyze zones of selective HB capture and battery current drain when pacing at different pulse durations (PDs). Methods:Consecutive patients with permanent HB pacing were studied. The RV and HB capture thresholds were assessed at several PDs. Battery current drain and zones of selective HB capture at PDs of 0.1, 0.2, 0.4 and 1.0 ms were determined. Results:In the whole group (n =127) the HB chronaxie was shorter than the RV chronaxie. This difference was driven by patients with selective HB pacing (HB chronaxie of 0.47 vs RV chronaxie of 0.79 ms). Strength-duration curve for HB had lower rheobase and its steep portion started at shorter PDs thus creating wider distance -zone of programmable selective HB pacing -between the HB and RV strength-duration curves at shorter PDs. The battery current drain was lower with pacing at PDs of 0.1 -0.4 ms vs 1.0 ms. Chronaxie adjusted PDs offered lowest current drain. Conclusion: For the first time the strength-duration curves for permanent selective and nonselective HB pacing were determined. Selective HB capture and battery longevity can be promoted by shorter PDs (0.2 ms). Longer PDs (1.0 ms) offer bigger safety margin for RV capture and may be preferable if simultaneous RV capture during HB pacing is desired.

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“…It is free from many of the known detrimental effects of conventional right ventricular (RV) pacing and might reverse the clinical course and structural changes induced by RV pacing and bundle branch blocks. [1][2][3][4][5] With the growing number of patients with permanent HB pacing devices, [6][7][8][9][10][11] determination of basics of this form of pacing, such as chronaxie, rheobase, and strength-duration curves, seems important. Rheobase is defined as the smallest voltage amplitude that captures the tissue at an infinitely long pulse duration.…”

Section: Introductionmentioning

confidence: 99%

His bundle has a shorter chronaxie than does the adjacent ventricular myocardium: Implications for pacemaker programming

et al. 2019

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BACKGROUND Strength-duration curves for permanent His bundle (HB) pacing are potentially important for pacemaker programming.OBJECTIVES We aimed to calculate strength-duration curves and chronaxies of the HB and of the adjacent right ventricular (RV) working myocardium and to analyze zones of selective HB capture and battery current drain when pacing at different pulse durations (PDs).METHODS Consecutive patients with permanent HB pacing were studied. The RV and HB capture thresholds were assessed at several PDs. Battery current drain and zones of selective HB capture at PDs of 0.1, 0.2, 0.4, and 1.0 ms were determined. RESULTSIn the whole group (N 5 127), the HB chronaxie was shorter than the RV chronaxie. This difference was driven by patients with selective HB pacing (HB chronaxie 0.47 ms vs RV chronaxie 0.79 ms). The strength-duration curve for the HB had a lower rheobase and its steep portion started at shorter PDs, thus creating wider distance-zone of programmable selective HB pacing-between the HB and RV strength-duration curves at shorter PDs. The battery current drain was lower with pacing at PDs of 0.1-0.4 ms vs 1.0 ms. Chronaxie-adjusted PDs offered the lowest current drain.CONCLUSION For the first time, the strength-duration curves for permanent selective and nonselective HB pacing were determined. Selective HB capture and battery longevity can be promoted by shorter PDs (0.2 ms). Longer PDs (1.0 ms) offer greater safety margin for RV capture and may be preferable if simultaneous RV capture during HB pacing is desired.

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His‐bundle pacing as a standard approach in patients with permanent atrial fibrillation and bradycardia

Abstract: HB pacing can be used as an alternative standard method of pacing in atrial fibrillation patients.

Cited by 31 publications

References 16 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

His bundle has shorter chronaxie than adjacent ventricular myocardium: Implications for pacemaker programming

His bundle has a shorter chronaxie than does the adjacent ventricular myocardium: Implications for pacemaker programming

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