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Electroanatomic mapping system guided His bundle pacemaker implantation: experience of the His bundle registry graz
FUNDING ACKNOWLEDGEMENTS: Type of funding sources: None. BACKGROUND: Electric conduction disturbances are very common, however, patients in need for ventricular pacing may suffer from pacing-induced heart failure due to unphysiological pacing by the right ventricular lead. Conducting system pacing a...
Autores principales: | , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Oxford University Press
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10207107/ http://dx.doi.org/10.1093/europace/euad122.391 |
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author | Benedikt, M Rohrer, U Prenner, G Sereinigg, M Zweiker, D Manninger, M Bisping, E Eberl, A Riedlbauer, R Lercher, P Zirlik, A Scherr, D |
author_facet | Benedikt, M Rohrer, U Prenner, G Sereinigg, M Zweiker, D Manninger, M Bisping, E Eberl, A Riedlbauer, R Lercher, P Zirlik, A Scherr, D |
author_sort | Benedikt, M |
collection | PubMed |
description | FUNDING ACKNOWLEDGEMENTS: Type of funding sources: None. BACKGROUND: Electric conduction disturbances are very common, however, patients in need for ventricular pacing may suffer from pacing-induced heart failure due to unphysiological pacing by the right ventricular lead. Conducting system pacing allows to overcome this common issue with a more physiologic approach, but real-life procedural data using this technology is scarce. METHODS: We report a single centre experience of the first 63 consecutive patients being implanted with a His-bundle-based pacemaker 09/2020-11/2022 per 3D-mapping guided implantation due to bradyarrhythmia, or for cardiac resynchronisation therapy in heart failure combined with a left-ventricular lead (HOT-CRT) ± a right ventricular defibrillator lead. The identification of the His-bundle-location was done with a 3D electroanatomic mapping system via an introducing sheath that is provided with electrodes at its tip. RESULTS: Mean age was 71 [18;87] years, 18/63 (29%) patients were female, mean baseline LVEF was 46±15%. Baseline ECG was captured before implantation: QRS width was 127±34ms, with typical LBBB in 19/63 (30%), typical RBBB in 5/63 (8%), alternating BBB in two patient (3%) and either no BBB or ventricular escape rhythm in 37/63 (59%). Indications for implantation were AV-block grade II-III in 31/63 (49%), primary prophylactic ICD indication in HFrEF in 18/63 (29%), atrial fibrillation with bradycardic conduction in 8/63 patients (13%), sick-sinus-syndrome in 4/63 (7%) and secondary prophylactic ICD indication in one patient (2%). In 57/63 (90,5%) a primary device was implanted, in 6/63 (9,5%) a pre-existent device was upgraded with a HB lead. Therefore, 23 dual-chamber-pacemaker, 5 single-chamber-pacemaker, 10 single-chamber CRT-P, 17 dual-chamber CRT-P, 4 single-chamber CRT-D, 4 dual-chamber CRT-D were implanted. In 63 patients his bundle pacing was attempted, while in 6/63 (9%) patients outside of this analysis the attempt was not successful, these patients were consecutively implanted with a non-HBP-device and therefor excluded from the further analysis. In the 63 patients included in this analysis with a primary successful pacing at the his-position, 5/63 (8%) his-bundle-leads dislocated within the first 48 hours, leading to a secondary success rate of 92%. There were two post-procedural pneumothorax that needed drainage, no major procedure-related complications occurred. Median skin-to skin procedure time was 111±47 minutes in his-bundle-device-implantation. The paced QRS width at the post-implantation follow up was 113±27ms with a change in QRS width of -15±39ms (+72; -92ms). The mean his-bundle sensing was 5,38±5,6mV and the mean threshold 1,1±0,86V over 1,0±0,5ms (0,4;1,5ms). The proportion of ventricular pacing was 75±36%. CONCLUSION: Electroanatomic-guided His bundle pacing as a new innovative technic for physiological pacing is viable including high implantation success rate as well as electric impact, both regarding QRS width and pacing threshold. |
format | Online Article Text |
id | pubmed-10207107 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Oxford University Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-102071072023-05-25 Electroanatomic mapping system guided His bundle pacemaker implantation: experience of the His bundle registry graz Benedikt, M Rohrer, U Prenner, G Sereinigg, M Zweiker, D Manninger, M Bisping, E Eberl, A Riedlbauer, R Lercher, P Zirlik, A Scherr, D Europace 14.1 - Antibradycardia Pacing FUNDING ACKNOWLEDGEMENTS: Type of funding sources: None. BACKGROUND: Electric conduction disturbances are very common, however, patients in need for ventricular pacing may suffer from pacing-induced heart failure due to unphysiological pacing by the right ventricular lead. Conducting system pacing allows to overcome this common issue with a more physiologic approach, but real-life procedural data using this technology is scarce. METHODS: We report a single centre experience of the first 63 consecutive patients being implanted with a His-bundle-based pacemaker 09/2020-11/2022 per 3D-mapping guided implantation due to bradyarrhythmia, or for cardiac resynchronisation therapy in heart failure combined with a left-ventricular lead (HOT-CRT) ± a right ventricular defibrillator lead. The identification of the His-bundle-location was done with a 3D electroanatomic mapping system via an introducing sheath that is provided with electrodes at its tip. RESULTS: Mean age was 71 [18;87] years, 18/63 (29%) patients were female, mean baseline LVEF was 46±15%. Baseline ECG was captured before implantation: QRS width was 127±34ms, with typical LBBB in 19/63 (30%), typical RBBB in 5/63 (8%), alternating BBB in two patient (3%) and either no BBB or ventricular escape rhythm in 37/63 (59%). Indications for implantation were AV-block grade II-III in 31/63 (49%), primary prophylactic ICD indication in HFrEF in 18/63 (29%), atrial fibrillation with bradycardic conduction in 8/63 patients (13%), sick-sinus-syndrome in 4/63 (7%) and secondary prophylactic ICD indication in one patient (2%). In 57/63 (90,5%) a primary device was implanted, in 6/63 (9,5%) a pre-existent device was upgraded with a HB lead. Therefore, 23 dual-chamber-pacemaker, 5 single-chamber-pacemaker, 10 single-chamber CRT-P, 17 dual-chamber CRT-P, 4 single-chamber CRT-D, 4 dual-chamber CRT-D were implanted. In 63 patients his bundle pacing was attempted, while in 6/63 (9%) patients outside of this analysis the attempt was not successful, these patients were consecutively implanted with a non-HBP-device and therefor excluded from the further analysis. In the 63 patients included in this analysis with a primary successful pacing at the his-position, 5/63 (8%) his-bundle-leads dislocated within the first 48 hours, leading to a secondary success rate of 92%. There were two post-procedural pneumothorax that needed drainage, no major procedure-related complications occurred. Median skin-to skin procedure time was 111±47 minutes in his-bundle-device-implantation. The paced QRS width at the post-implantation follow up was 113±27ms with a change in QRS width of -15±39ms (+72; -92ms). The mean his-bundle sensing was 5,38±5,6mV and the mean threshold 1,1±0,86V over 1,0±0,5ms (0,4;1,5ms). The proportion of ventricular pacing was 75±36%. CONCLUSION: Electroanatomic-guided His bundle pacing as a new innovative technic for physiological pacing is viable including high implantation success rate as well as electric impact, both regarding QRS width and pacing threshold. Oxford University Press 2023-05-24 /pmc/articles/PMC10207107/ http://dx.doi.org/10.1093/europace/euad122.391 Text en © The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (https://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com |
spellingShingle | 14.1 - Antibradycardia Pacing Benedikt, M Rohrer, U Prenner, G Sereinigg, M Zweiker, D Manninger, M Bisping, E Eberl, A Riedlbauer, R Lercher, P Zirlik, A Scherr, D Electroanatomic mapping system guided His bundle pacemaker implantation: experience of the His bundle registry graz |
title | Electroanatomic mapping system guided His bundle pacemaker implantation: experience of the His bundle registry graz |
title_full | Electroanatomic mapping system guided His bundle pacemaker implantation: experience of the His bundle registry graz |
title_fullStr | Electroanatomic mapping system guided His bundle pacemaker implantation: experience of the His bundle registry graz |
title_full_unstemmed | Electroanatomic mapping system guided His bundle pacemaker implantation: experience of the His bundle registry graz |
title_short | Electroanatomic mapping system guided His bundle pacemaker implantation: experience of the His bundle registry graz |
title_sort | electroanatomic mapping system guided his bundle pacemaker implantation: experience of the his bundle registry graz |
topic | 14.1 - Antibradycardia Pacing |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10207107/ http://dx.doi.org/10.1093/europace/euad122.391 |
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