His bundle pacing: 10-years follow-up

FUNDING ACKNOWLEDGEMENTS: Type of funding sources: None. BACKGROUND: His bundle pacing (HBP) ensures a physiologic ventricular activation and can prevent pacing-induced cardiomyopathy. Published experiences confirm good clinical results on short-term follow-up. Data on long-term follow-up are still lacking OBJECTIVE: analyze clinical and technical results of HBP in an unselected population during a very long-term follow-up. METHODS: We retrospectively analyzed 370 patients (mean age 75±8 years; 221 males) with standard indication for pacing implanted with HBP from 2003 to 2012. In all cases the HBP implant was performed by lumenless fixed screw 3830 Medtronic and deflectable sheath C304. In 52% cases selective-HBP was obtained while 48% was non selective-HBP. The indications for pacing were AV block in 51%, sinus node disease in 22%, atrial fibrillation with slow ventricular rate in 25%, heart failure in 2%. Ischemic cardiopathy was found in 84 patients (29%); hypertension in 317 patients (86%) and diabetes in 108 patients (29%). Pre-implant QRS duration was 119±30 ms and basal mean EF 57±11%. The Hisian lead was inserted in ventricular port of a CRT-P device in 162 (44%) patients, in the atrial port of a DR device in 183 (49%) patients, and in the only channel of a SR device in 25 (7%) patients. A back-up standard lead was implanted in right ventricular apex or septum in 203 (55%) patients. RESULTS: All patients were followed by ambulatory check once a year. 124 (34%) patients reached 10 years follow-up (mean 12.3 ±1.8 years). At the end of follow-up, the mean EF was 61±8% (P=NS) and the mean paced QRS duration 123 ± 27 (P=NS). 10 (8%) patients had heart failure hospitalizations. 26 (21%) died after a mean of 12.1 ±1.7 years. From a technical point of view, 99 (80%) patients showed a good performance of the HBP lead at the last follow-up while 25 (20%) patients experienced lead-related problems: 20 (16%) had issues related to HBP lead (2 cases of severe HBP malfunction required hospitalization due to syncope) and 5 (4%) had malfunction of the back-up lead. The mean longevity of the devices was 6.6 ±2.6 years and each patient had 1.5 ±0.8 replacements. It was required to add a back up catheter in 3.6% of patients. The remaining 205 patients completed a mean follow-up of 6.3±2.7 years while 41(11%) patients were lost at follow-up (died within the first month post-implant or checked in other centres). CONCLUSION: HBP is safe and feasible in the clinical practice. The system maintains a good performance during a long-term follow-up and ensures a physiologic ventricular contraction thus allowing good clinical outcome. The EF and QRS duration remain in normal values. [Figure: see text]