Non-selective His bundle pacing with a biphasic waveform: enhancing septal resynchronization

Ortega, Daniel F.; Barja, Luis D.; Logarzo, Emilio; Marilleau, Nicolas; Paolucci, Analía; Bonomini, Maria Paula

doi:10.1093/europace/eux098

Cited by 13 publications

(5 citation statements)

References 17 publications

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“…In fact, the Synchromax ® technique discussed here was born from the thorough research of para-Hisian pacing (therefore NSHBP, but we adopted the former terminology) and the resulting ECG patterns. By performing parallel comparative analysis with tissue echo and intracardiac pressures we have confirmed that correlation with acute hemodynamic parameters is excellent [4]. Having 10year experience with the Synchromax ® method, we are sure that we have simplified para-Hisian pacing (and therefore physiological pacing), reaching over 500 such implants [5] (Figure 3).…”

mentioning

confidence: 74%

Non Selective his Bundle Pacing: As Physiological as S-HBP but Simpler and Faster

DF¹,

Logarzo²,

Paolucci³

et al. 2022

austinjclincardiolog

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We have read with interest Dr. Burri’s Electrocardiographic Analysis for His Bundle Pacing at Implantation and Follow up [1]. A comprehensive guide to understand electrocardiographic (ECG) nuances of His Bundle Pacing (HBP) is presented in this review. The authors, with outstanding didactics, describe a well-organized analysis of challenging HBP electrocardiographic characteristics to confirm conduction tissue (selective or non-selective HBP) at implant and follow-up. Caught our interest, in particular, the paragraph where practical pacing characteristics and benefits of non-selective HBP pacing (NSHBP) are emphasized. In this context we would like to point out the statement that pacing “ventricular myocardium adjacent to the atrioventricular septum, near the His bundle can also result in NSHBP”. Above all, of paramount clinical importance, when Dr. Burri et al. conclude that “No significant differences in cardiac mechanical synchrony or clinical outcome have been found between SHBP and NSHBP”. Our group is in total agreement with these essential features, having abandoned SHBP many years ago by developing a very simple technique to place standard pacing leads in the para-Hisian area (Figure 1). Concordant with the authors, we understand that “With non-selective His bundle pacing (NS-HBP), the lead is usually positioned in the ventricle at a site where the His bundle (HB) is surrounded by or at proximity to myocardial tissue”. That is why we named “para-Hisian pacing”. In our daily practice, at the same time, to verify and prove physiological capture of the conduction system we monitor synchrony online by analyzing the ECG signal variance [8] (Synchromax®) [2].

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mentioning

confidence: 74%

Non Selective his Bundle Pacing: As Physiological as S-HBP but Simpler and Faster

DF¹,

Logarzo²,

Paolucci³

et al. 2022

austinjclincardiolog

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“…de concordância das deflexões intrinsecoides dos QRS (Figura 2A). 12,22,23 Valores de IimeS < 0,40 são considerados normais (sincrônico); valores de IimeS > 0,41 e < 0,69 são considerados dissincronia moderada; e valores de IimeS > 0,7 são considerados dissincronia severa (Figura 2B). 11,19,21 A abordagem e a captura do feixe de His (grupo DDD-His) foram feitas através de duas vias.…”

Section: Metodologiaunclassified

Sincronia Ventricular na Estimulação Cardíaca Parahissiana: Alternativa por Ativação Cardíaca Fisiológica (Estimulação Indireta do Feixe de His)?

Ferrari¹,

Gazzoni²,

Domingues³

et al. 2021

Arquivos Brasileiros De Cardiologia

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Resumo Fundamento A estimulação cardíaca artificial (ECA) por captura direta ou indireta do feixe de His resulta em contração ventricular sincrônica (ECA fisiológica). Objetivos Comparar sincronia cardíaca, características técnicas e resultados de parâmetros eletrônicos entre duas técnicas de ECA indireta do feixe de His: a não seletiva e a parahissiana. Métodos Intervenção experimental (novembro de 2019 a abril de 2020) com implante de marca-passo definitivo (MPd) DDD em pacientes com fração de ejeção ventricular esquerda > 35%. Foram comparadas a sincronia cardíaca resultante mediante algoritmo de análise eletrocardiográfica da variância espacial do QRS e as características técnicas associadas a cada método entre ECA hissiana não seletiva (DDD-His) e parahissiana (DDD-Var). Resultados De 51 pacientes (28 homens), 34 (66,7%) foram alocados no grupo DDD-Var e 17 (33,3%), no grupo DDD-His, com idade média de 74 e 79 anos, respectivamente. No grupo DDD-Var, a análise da variância espacial do QRS (índice de sincronia ventricular) mostrou melhora após o implante de MPd (p < 0,001). Ao ECG pós-implante, 91,2% dos pacientes do grupo DDD-Var mostraram padrão fisiológico de ECA, comprovando ativação similar à do DDD-His (88,2%; p = 0,999). O eixo do QRS estimulado também foi similar (fisiológico) para ambos os grupos. A mediana do tempo de fluoroscopia do implante foi de 7 minutos no grupo DDD-Var e de 21 minutos no DDD-His (p < 0,001), favorecendo a técnica parahissiana. A duração média do QRS aumentou nos pacientes do DDD-Var (114,7 ms pré-MPd e 128,2 ms pós-implante, p = 0,044). A detecção da onda R foi de 11,2 mV no grupo DDD-Var e de 6,0 mV no DDD-His (p = 0,001). Conclusão A ECA parahissiana comprova recrutamento indireto do feixe de His, mostrando-se uma estratégia eficaz e comparável à ECA fisiológica ao resultar em contração ventricular sincrônica similar à obtida por captura hissiana não seletiva.

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“…Consensus has not been reached on the use of either non-selective or selective His-bundle pacing, and the widespread use of these techniques is precluded by their complexity, costly equipment, increased risk of complications and reinterventions, high pacing thresholds, shorter battery life, uncertainty regarding long-term safety, and a significantly longer learning curve. 4 , 10 In addition, a mapping system and the presence of an electrophysiologist trained on His-bundle mapping are often required during these procedures, which may constitute another limitation, as cardiac pacing devices are usually implanted by cardiovascular surgeons in developing countries. Conversely, increasing evidence has led to the rapid adoption of CSP via left bundle branch area pacing (LBBAP), which is more straightforward and capable of overcoming the downside of His-bundle pacing.…”

Section: Introductionmentioning

confidence: 99%

“…CCA is a non-invasive, sensitive, and practical method with a high predictive value for detecting LV electrical synchrony and asynchrony and was also shown to have a very good correlation with synchronous mechanical activity. 8 , 10 , 18 – 20 The use of CCA during permanent pacemaker (PPM) implantation at the RVOT can simplify and standardize the implant procedure, making synchronous electromechanical activity more accessible and achievable. The objective of this single-center, retrospective study was to investigate an alternative site (RVOT) for PPM lead implantation with the goal of achieving more physiological pacing.…”

Section: Introductionmentioning

confidence: 99%

Permanent Cardiac Pacing of the Right Ventricular Outflow Tract Guided by Real-time Assessment of Electromechanical Synchrony

VENTURA,

VIOLA,

FERRARI

2024

J Innov Cardiac Rhythm Manage.

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Non-selective His bundle pacing with a biphasic waveform: enhancing septal resynchronization

Abstract: AF-nHB corrected bundle branch blocks in patients with severe conduction disturbances, even in those with dilated cardiomiopathy, outstanding from RVA. Also, the occurrence of cardiac memory during AF-nHB turned up as an observational finding of this study.

Cited by 13 publications

References 17 publications

Non Selective his Bundle Pacing: As Physiological as S-HBP but Simpler and Faster

Non Selective his Bundle Pacing: As Physiological as S-HBP but Simpler and Faster

Sincronia Ventricular na Estimulação Cardíaca Parahissiana: Alternativa por Ativação Cardíaca Fisiológica (Estimulação Indireta do Feixe de His)?

Permanent Cardiac Pacing of the Right Ventricular Outflow Tract Guided by Real-time Assessment of Electromechanical Synchrony

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