Programmed His Bundle Pacing

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

doi:10.1161/circep.118.007052

Cited by 37 publications

(31 citation statements)

References 9 publications

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“…Interestingly, the myocardial response during programmed LBB pacing was observed less frequently than during programmed HB pacing (74.8% vs. 100%). 9 This might be related to the lower percentage of cases with HPS capture during deep septal pacing as compared to HB pacing. However, a non-diagnostic response was also observed in cases with a bona fide LBB capture (non-diagnostic response with extrastimuli delivered during intrinsic rhythm yet diagnostic response with extrastimuli delivered after a drive train - and vice versa ).…”

Section: Discussionmentioning

confidence: 99%

“…Perhaps the occasional lack of myocardial response during ns-LBB capture can be also explained by a smaller difference between ERPs of HPS and adjacent myocardium during LBB pacing as compared to HB pacing, 55 ms vs. 81.9 ms, respectively. 9 This gives a smaller ‘opportunity’ for the extrastimuli to capture only the adjacent myocardium. It is also possible that in some cases the myocardial QRS and ns-LBB QRS are too similar and the loss of HPS capture is difficult/impossible to establish by analysis of changes of QRS morphology.…”

Section: Discussionmentioning

confidence: 99%

“…myocardial capture QRS and/or selective HB capture QRS. 9 We hypothesized that programmed pacing will be able to provide definitive diagnosis of LBB capture in a similar fashion; this was never investigated before.…”

Section: Introductionmentioning

confidence: 99%

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Programmed deep septal pacing for the diagnosis of left bundle branch capture

Jastrzębski

Moskal

Kusiak³

et al. 2019

Preprint

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Introduction Permanent deep septal stimulation with capture of the left bundle branch (LBB) enables maintenance/restoration of the physiological activation of the left ventricle. However, it is almost always accompanied by the simultaneous engagement of the local septal myocardium, resulting in a fused (nonselective) QRS complex, therefore, confirmation of LBB capture remains difficult. Methods We hypothesized that programmed extrastimulus technique can differentiate nonselective LBB capture from myocardial‐only capture as the effective refractory period (ERP) of the myocardium is different from the ERP of the LBB. Consecutive patients undergoing pacemaker implantation underwent programmed stimulation delivered from the lead implanted in a deep septal position. Responses to programmed stimulation were categorized on the basis of sudden change in the QRS morphology of the extrastimuli, observed when ERP of LBB or myocardium was encroached upon, as: “myocardial,” “selective LBB,” or nondiagnostic (unequivocal change of QRS morphology). Results Programmed deep septal stimulation was performed 269 times in 143 patients; in every patient with the use of a basic drive train of 600 milliseconds and in 126 patients also during intrinsic rhythm. The average septal‐myocardial refractory period was shorter than the LBB refractory period: 263.0 ± 34.4 vs 318.0 ± 37.4 milliseconds. Responses diagnostic for LBB capture (“myocardial” or “selective LBB”) were observed in 114 (79.7%) of patients. Conclusions A novel maneuver for the confirmation of LBB capture during deep septal stimulation was developed and found to enable definitive diagnosis by visualization of both components of the paced QRS complex: selective paced LBB QRS and myocardial‐only paced QRS.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Programmed deep septal pacing for the diagnosis of left bundle branch capture

Jastrzębski

Moskal

Kusiak³

et al. 2019

Preprint

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“…Selective HBP (S‐HBP) or nonselective HBP (NS‐HBP), conduction disturbance correction or noncorrection were defined according to the recommendations from a multicentre collaborative working group 4 based on intracardiac recording and paced QRS morphology. In case of NS‐HBP with only one morphology, we used the pacing maneuver suggested by Jastrzębski et al 10 to confirm His capture. The pacing lead was rotated clockwise without releasing the lead between rotations.…”

Section: Methodsmentioning

confidence: 99%

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

Zanon

Marcantoni

Zuin

et al. 2020

Cardiovasc electrophysiol

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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.

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“…14,15 Programmed His bundle pacing method for differentiation between RV QRS and non-selective HB QRS was applied when considered necessary. 16 Selective and non-selective HB capture was identified according to the recently proposed criteria. 17 For the purpose of this study, a patient was categorized as having selective HB capture lead position if HB threshold was below RV threshold with at least one voltage and pulse width combination.…”

Section: Methodsmentioning

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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Programmed His Bundle Pacing

Cited by 37 publications

References 9 publications

Programmed deep septal pacing for the diagnosis of left bundle branch capture

Programmed deep septal pacing for the diagnosis of left bundle branch capture

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

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

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