scholarly journals The back-up lead in his bundle pacing: evolution over the years

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
F Zanon ◽  
L Marcantoni ◽  
G Pastore ◽  
E Baracca ◽  
C Picariello ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Node ◽  
Rapid Reduction ◽  
His Bundle ◽  
His Bundle Pacing ◽  
Conduction Disturbances ◽  
Node Disease ◽  
Qrs Duration ◽  
Fixed Curve ◽  
Lead Fixation

Abstract Background His bundle pacing (HBP) can be affected by high thresholds and low sensing. Thus, in selected patients including a back-up lead is advisable. Objective Single-centre retrospective analysis of a large HBP experience, focusing on the back-up lead utilization over the years. Methods 677 pts (76±8 years; 433 males) were implanted with HBP from 2004 to 2019 July. The pts received S-HBP (67%) or NS-HBP by the 3830 lead. The pacing indications were AV block 54%, sinus node disease 17%, slow atrial fibrillation 23%, heart failure 6%. Ischemic cardiopathy was found in 26%; hypertension in 83%, diabetes in28% pts. Baseline QRS duration was 123±32 ms and EF 56±12%. Results 266 (39%) pts received the back-up lead. In sinus rhythm we implanted 3-chamber PM (His lead:LV port; VV delay 80 ms: His pulses and apical pacing during the refractory period). 30 pts (11%) received a particular type of 3-chamber PM which provides back-up pacing only if His capture fails, thus saving energy. In atrial fibrillation 2-chamber PM was implanted (His lead: atrial port, DVI). We recorded a significant decrease of back-up lead use over the years, strictly related to operators/centre experience (>70% during the first years, nearly 10% during the last year). The C315 fixed curve sheath, strongly contributed to the rapid reduction of back-up lead use thanks to better lead fixation and stability. Conclusion The back-up lead utilization is progressively decreasing. It is strictly related to the operator/centre experience. The presence of the back-up lead could strengthen the Hisian pacing reliability, potentially impacting pacing indication even in advanced conduction disturbances and saving device longevity. Funding Acknowledgement Type of funding source: None

Abstract 20082: Feasibility of His Bundle Pacing in Patients Meeting Criteria for Cardiac Resynchronization Therapy and Implantable Cardioverter-defibrillator

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Olujimi A Ajijola ◽  
Carlos Macias ◽  
Vinisha Garg ◽  
Gabriel Vorobiof ◽  
Alison H Mally ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Pulse Generator ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
His Bundle ◽  
His Bundle Pacing ◽  
Permanent Atrial Fibrillation ◽  
Pacing Lead ◽  
Qrs Duration

Objective: The role of His bundle pacing to physiologically narrow QRS duration in patients meeting criteria for CRT/CRT-D is not well understood. Methods: Patients with CRT/CRT-D indication with failed CS lead placement, suboptimal coronary venous targets, or those who opted for His bundle pacing underwent implantation of a His bundle lead, along with an RV defibrillator lead if indicated. In all patients, the His bundle pacing lead was placed into the LV lead port with CRT pulse generator. The LV-RV offset was programmed at maximum, with RV lead subthreshold to minimize fusion. An atrial lead was implanted if the patient was not in permanent atrial fibrillation. Results: Thirteen patients (65±18 years, 7 males, mean LVEF 27.3±8.9%, QRS duration 180±30ms, and 11 with LBBB) underwent His bundle pacing. The mean PR interval in this cohort was 220±111ms, 3 patients had complete heart block, 3 had permanent atrial fibrillation, and 9 required ICD placement. The His pacing lead (Medtronic 3830 Select Secure) was successfully placed in 12 of 13 patients, with narrowing of the QRS duration to 120±23ms (p<0.0001). No complications or lead dislodgements were seen. At 6-month follow up, LVEF increased by an average of 18.7%, and left ventricular internal dimension in diastole(LVIDd) decreased by 0.9cm. Echocardiographic global longitudinal strain improved from -9.1 to -10.5%. Conclusions: In patients meeting criteria for CRT/CRT-D implantation, QRS narrowing achieved by His bundle pacing is feasible, and is associated with favorable mechanical and clinical outcomes.

His-bundle pacing in CHF-patients with narrow QRS and chronic AF – an upgrade from single-chamber to dual-chamber ICD

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Ciesielski ◽  
A Slawuta ◽  
A Zabek ◽  
K Boczar ◽  
B Malecka ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Clinical Status ◽  
Chronic Atrial Fibrillation ◽  
Dual Chamber ◽  
Icd Implantation ◽  
Single Chamber ◽  
His Bundle ◽  
His Bundle Pacing ◽  
Short Period

Abstract   A single-chamber ICD is a standard method for primary SCD prophylaxis. In patients with chronic atrial fibrillation it does not contribute to the regularization of heart rate, which is crucial for proper treatment. Moreover, to avoid the deleterious effect of right ventricular pacing only minority of the patients with single chamber ICD get the appropriate, recommended dose of beta-blockers. The aim of our study was to assess the efficacy of direct His-bundle pacing in a population of patients with congestive heart failure and chronic atrial fibrillation using upgrade from single chamber to dual-chamber ICD and atrial channel to perform the His-bundle pacing Methods The study population included 39 patients (37 men, 2 women) aged 67.2±9.3 years, with CHF and chronic AF implanted primarily with single chamber ICD with established pharmacotherapy and stable clinical status. Results The echocardiography measurements at baseline and during follow-up were presented in the table: During short period (3–6 months) of follow-up the mean values of EF and LV dimensions significantly improved. This was also accompanied by functional status improvement. Conclusions His-bundle-based pacing in CHF-chronic AF patients contributes to significant echocardiographic and clinical improvement. Standard single-chamber ICD implantation in CHF-chronic AF patients yields only SCD prevention without influence on remodeling process. The physiological pacing contributes to better pharmacotherapy. Funding Acknowledgement Type of funding source: None

Abstract 15078: Non-selective but Not Selective His Bundle Pacing Uniquely Resolves Acute and Chronic Right Bundle Branch Block

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Rehan Mahmud ◽  
Shakeel Jamal ◽  
Bdeth Bailey
Keyword(s):  
Right Bundle Branch Block ◽  
Complete Resolution ◽  
Conduction Block ◽  
Right Ventricular Free Wall ◽  
Bundle Branch Block ◽  
His Bundle ◽  
His Bundle Pacing ◽  
Partial Resolution ◽  
Lead Fixation

Introduction: While acute (Ac) right bundle branch block (RBBB) may be in proximal HB (lead fixation injury) and chronic (Ch) RBBB in distal HB, they both cause terminal QRS delay. Both types of RBBB may be corrected with non-selective (NS) His bundle pacing (HBP), however the mechanism is unknown. Hypothesis: To study the role of high (5V) and low (1V) pacing voltage as well as presence of pre-excitation (in NS-HBP) in resolving Ac and chronic Ch-RBBB. Methods: Of the thirty-nine patients (27 ChRBBB and 12 AcRBBB), 25 ChRBBB and 10 AcRBBB patients showed NS-HBP at 5V and 11/25 ChRBBB and 6/12 AcRBBB patients transitioned to selective (S)-HBP at 1V. Four patients showed S-HBP at 5V and 1V. Results: 1)During NS-HBP at 5V: (In 25 ChRBBB and 10 Ac-RBBB) Complete resolution occurred 12/25ChRBBB and in all 10 AcRBBB. A partial resolution of ChRBBB occurred 13/25 ChRBBB.2. During NS-HBP at 1V: (6/14 ChRBBB and 2/4 AcRBBB showed complete resolution at 1V, remainder showed incomplete RBBB3. During S-HBP at 5V : (2 ChRBBB 2 AcRBBB) only 1 AcRBBB showed resolution of RBBB. 4. During S-HBP at 1V : All 13 ChRBBB and 8 AcRBBB did not show resolution os RBBB including 11 Ch-RBBB and 6 Ac-RBBB RBBB which resolved during 5V NS-HBP, abruptly recurred on transition to S-HBP at a mean of 2.4±0.8V. Conclusions: 1)The lack of RBBB resolution with S-HBP suggests that pacing site was proximal to site of block, however, from the same site NS-HBP either completely or incompletely resolved both Ac- and Ch-RBBB. 2) Partial resolution of RBBB in NS-HBP may be explained by right ventricular free wall pre-excitation when site of Ch-RBBB is distal.3) Complete resolution of both acute and Ch-RBBB in NS-HBP, more so at high pacing voltage, suggest that peri-Hisian tissues may behave more like a specialized conduction tract which uniquely resolves conduction block.

Atrial tachyarrhythmias in bradycardia–tachycardia syndrome: characterization and evolution

ESC CardioMed ◽  
2018 ◽  
pp. 1954-1957
Author(s):  
Luigi Padeletti ◽  
Roberto De Ponti
Keyword(s):  
Atrial Fibrillation ◽  
Atrial Flutter ◽  
Sinus Node ◽  
Ventricular Myocardium ◽  
Sinus Node Dysfunction ◽  
Ventricular Pacing ◽  
Atrial Tachyarrhythmia ◽  
Atrial Tachyarrhythmias ◽  
Node Disease ◽  
Sinus Node Disease

The association of sinus node disease and atrial tachyarrhythmias characterizes the bradycardia–tachycardia syndrome, which may result in an increased risk of heart failure, stroke, and death. Ageing and several cardiac and extracardiac diseases, which have the potential to affect both the atrial and the ventricular myocardium, can manifest their influence predominantly on the atria, leading to an atrial cardiomyopathy. In these cases, the same pathological process which leads to sinus node dysfunction can create a favourable substrate also for atrial tachyarrhythmias, which, if not present at the time of the initial diagnosis of the sinus node disease, can occur with an increasing prevalence during follow-up. In younger patients with no evident structural heart disease, a bradycardia–tachycardia syndrome may be the first clinical and unexpected manifestation of a still undiagnosed inherited genetic disease and therefore a specific diagnostic workup is necessary. In bradycardia–tachycardia syndrome, the most frequently encountered atrial tachyarrhythmia is atrial fibrillation, while typical atrial flutter is rarer. In peculiar subgroups of patients, other atrial tachyarrhythmias, such as atypical atrial flutter, macroreentrant or focal atrial tachycardia, may be present. In bradycardia–tachycardia syndrome, the evolution of atrial tachyarrhythmias clearly shows a worsening with an prevalence of associated atrial tachyarrhythmia over time. Pharmacological therapy for arrhythmias is of limited use, due to the concomitant sinus node dysfunction. The modality of pacing used to manage the sinus node disease has to be carefully chosen to minimize the evolution of atrial tachyarrhythmias. In fact, while ventricular pacing increases the incidence of atrial fibrillation and stroke, dual-chamber pacing with a specific algorithm for ventricular pacing minimization and prevention and treatment of atrial tachyarrhythmias reduces a composite endpoint of evolution to permanent atrial fibrillation, hospitalization, and death.

P5675Ischemic stroke in patient with sinus node disease in comparison to atrial fibrillation, bradycardia-tachycardia syndrome and other cardiac conditions: a nationwide cohort-study

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A Bodin ◽  
A Bisson ◽  
N Clementy ◽  
B Pierre ◽  
J Herbert ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cohort Study ◽  
Ischemic Stroke ◽  
Sinus Node ◽  
Control Population ◽  
National Database ◽  
Control Group ◽  
Cardiac Condition ◽  
Node Disease ◽  
Sinus Node Disease

Abstract Atrial fibrillation (AF) may be associated with sinus node disease (SND) presenting as a brady-tachy syndrome (BTS), known to be at risk for embolic ischemic stroke (IS). It remains unclear whether the risk of IS is increased in patients with isolated SND. Methods This French longitudinal cohort study was based on the national database covering hospital care from for the entire population (PMSI) from 2010 to 2015. We compared incidences of IS in patients with a diagnosis of AF or SND to that in a control group of patients with a main diagnosis of cardiac condition (excluding those with AF or SND, history of stroke and mechanical valve or mitral stenosis). Results Of 1,732,412 patients included in the cohort, 1,601,435 (92.44%) had isolated AF, 102,849 (5.94%) had isolated SND and 28,128 (1.62%) had BTS. The control group with cardiac condition included 479,108 patients. Incidence of IS progressively increased when considering patients from the control population, patients with isolated SND, with BTS or with isolated AF (0.67%/yr, 1.95%/yr, 3.03%/yr and 5.48%/yr respectively). These differences were seen in all strata of CHA2DS2VASc score (table). SND patients with a CHA2DS2-VASc score ≥3 had a yearly incidence of IS >2%, comparable to AF population with a CHA2DS2-VASc score ≥1. Incidence (%/year) of ischemic stroke CHA2DS2-VASc AF population SND population “Control” population Women Men Women Men Women Men All scores 6.72% 4.37% 1.93% 1.96% 0.67% 0.68% Score = 0 – 1.960% – 1.211% – 0.217% Score = 1 2.337% 3.046% 0.538% 1.486% 0.166% 0.345% Score = 2 3.917% 4.499% 0.879% 1.541% 0.298% 0.580% Score = 3 7.572% 4.733% 2.207% 2.084% 0.541% 0.907% Score = 4 7.016% 4.820% 2.363% 2.305% 0.930% 1.278% Score = 5 6.725% 5.345% 2.845% 2.849% 1.249% 1.553% Score = 6 7.637% 7.543% 3.319% 4.109% 1.737% 2.031% Score = 7 10.196% 13.927% 4.663% 7.708% 2.346% 4.089% Score = 8 17.654% 12.607% 8.519% 11.904% 2.446% 2.355% Conclusion Patients with isolated SND had a lower risk of IS than patients with AF or BTS. However, SND patients had a non-neglectable risk of IS during follow-up which was higher than in a “control” population. Whether oral anticoagulation may bring a significant clinical benefit might be studied in patients with SND at highest risk of IS.

Pacing in sinus node disease to prevent atrial fibrillation

2012 ◽  
Vol 10 (7) ◽  
pp. 851-858 ◽  
Author(s):  
Mads Brix Kronborg ◽  
Jens Cosedis Nielsen
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Node ◽  
Node Disease ◽  
Sinus Node Disease

P1239His-bundle pacing in CHF-patients with narrow QRS and chronic AF using dual-chamber ICD

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A Slawuta ◽  
K Boczar ◽  
A Zabek ◽  
A Ciesielski ◽  
J Hiczkiewicz ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Congestive Heart Failure ◽  
Dual Chamber ◽  
His Bundle ◽  
His Bundle Pacing ◽  
Narrow Qrs ◽  
Group A ◽  
Group B

Abstract The heart rate regularization is crucial for proper treatment of patients with atrial fibrillation and congestive heart failure. The standard resynchronization can be applied, but in patients with narrow QRS this procedure is of no use. The aim of our study is to assess the efficacy of direct His-bundle pacing in patients with congestive heart failure and chronic atrial fibrillation using dual chamber ICD implanted for prevention of sudden cardiac death. Methods The study population included 78 patients with CHF and chronic AF: group A - 56 pts treated with direct His-bundle pacing using atrial port of dual chamber ICD and group B - 22 patients implanted with single chamber ICD as recommended by the guidelines. The patients in group B constituting clinical controls were derived from the Heart Failure Outpatients Clinic with established clinical status and pharmacotherapy. Results The demographic data, clinical characteristics and echocardiography measurements at baseline and during follow-up were presented in the table: Table 1 Group A Group B P value Age (years) 69.7±6.9 66.7±11.3 n.s. Sex (% of male sex) 84.0 86.4 n.s. Ventricular pacing (%) – 46.3±31.2 – His-bundle pacing (%) 81.7±9.2 – – pre post pre post pre vs. post LVEDD (mm) 66.9±4.9 59.9±4.7 64.8±8.0 64.7±8.1 <0.01 n.s. EF (%) 29.6±3.8 43.6±5.9 28.1±6.1 28.8±7.3 <0.01 n.s. NYHA class 2.7±0.6 1.4±0.6 2.5±0.6 2.0±0.2 <0.05 n.s. B-blocker dose (metoprolol equivalent dose) 104.6±41.6 214.3±82.6 78.3±56.6 103.1±49.2 <0.001 <0.05 During 12-months of follow-up the mean values of NYHA functional class, EF and LV dimensions did not change in group B but significantly improved in group A. The physiological His-bundle based pacing enabled optimal beta-blocker dosing. The studied groups had no tachyarrhythmia at baseline so the presumable atrial fibrillation-related harm depends on the rhythm irregularity. Conclusions His-bundle-based pacing in CHF-chronic AF patients contributes to significant echocardiographic and clinical improvement. Standard single-chamber ICD implantation in CHF-chronic AF patients yields only SCD prevention without influence on remodeling process. The CHF-patients with narrow QRS and chronic AF benefit from substantially higher beta-blockade which can be instituted in His-bundle pacing group.

Sign in / Sign up

Export Citation Format

Share Document