HIS BUNDLE PACING, THE FIRST EXPERIENCE USING A CONVENTIONAL PACEMAKER LEADS

Authors

  • Ammar Alhamdi Consultant Cardiologist and Electrophysiologist, Sulaimani, Kurdistan Region, Iraq.

DOI:

https://doi.org/10.17656/jsmc.10262

Keywords:

His pacing, Conventional pacemaker leads

Abstract

Background 

The classical pacing site at the right ventricular apex has been noticed to induce left ventricular function deterioration and heart failure over long pacing periods. Trials of right ventricular outflow tract pacing have been reported to reduce this problem in a few patients. 

Objectives 

His bundle pacing has been lately found to minimize pacing-induced cardiomyopathy significantly.

Materials and Methods

Patients included are those with high degree heart block, who needed conventional pacing and those with an indication for cardiac resynchronization therapy, where His bundle pacing was done as a substitute to a failed coronary sinus lead positioning for left ventricular epicardial pacing. His Bundle Pacing was done by blind His pacing site assessment through continuous ventricular pacing at the presumed His bundle site under fluoroscopy views. The leads used are conventional pacing leads. His bundle pacing was indicated by almost normal width paced QRS.

Results

His bundle pacing was successful in 30 patients from a total of 45 referred patients (67%). Fifteen patients with second or third-degree heart block who needed conventional pacing and 15 patients with an indication for cardiac resynchronization therapy, where His bundle pacing was done as a substitute to a failed coronary sinus lead positioning for left ventricular epicardial pacing. The 15 patients with high grades atrioventricular block did not show evidence of heart failure and dilated cardiomyopathy. The 15 patients with cardiac resynchronization therapy indication showed marked narrowing of the paced QRS, improvement in NYHA functional class, significant improvement of left ventricular ejection fraction, and reduction of cardiac size.

Conclusion

His bundle pacing is more physiological than right ventricular apical pacing and right ventricular outflow pacing as far as narrowing of the paced QRS, left ventricular function stability, and reduced incidence of pacing-induced cardiomyopathy. It is recommended in all conventional pacing indication. Whether patients with atrioventricular block or in cardiac resynchronization therapy indication when coronary sinus/left ventricular lead failed. Future availability of special leads and delivery system, improvement in leads, the design and positioning techniques at the His site may well improve the success rate of His bundle pacing and may replace left ventricular epicardial pacing in cardiac re synchronization therapy.

References

Khurshid S, Epstein AE, Verdino RJ, Lin D, Goldberg RL, Marchilinski FA, et al. Incidence and predictors of right ventricular pacing-induced cardiomyopathy. Heart Rhythm. 2014; (11):1619-1625. DOI: https://doi.org/10.1016/j.hrthm.2014.05.040

Khurshid S, Liang JJ, Owens A, Lin D, Schaller R, Epstein AF, et al .Longer paced QRS duration is associated with increased prevalence of right ventricular pacing-induced cardiomyopathy. L Cardiovasc Electrophysiol. 2016;27(10):1174-1179. DOI: https://doi.org/10.1111/jce.13045

Sweeney MO, Hellkamp AS, Ellenbogen KA, Greenspon AJ, Freedman RA, Lee KL, et al. Adverse effect of ventricular pacing on heart failure and atrial fibrillation among patients with normal baseline QRS duration in a clinical trial of pacemaker therapy for sinus node dysfunction. Circulation .2003; 107(23):2932-2937. DOI: https://doi.org/10.1161/01.CIR.0000072769.17295.B1

Kaye GC, Linker NJ, Marwick TH, Pollock L, Graham L, Pouliot E, et al. for the protect -pace trial investigators. Effect of right ventricular pacing lead site on left ventricular function in patients with high – grade atrioventrcular block: results of the protect-pace study. Eur Heart J. 2015; (36):856-62. DOI: https://doi.org/10.1093/eurheartj/ehu304

Vijayaraman P, Bordachar P, Ellenbogen KA. The continued search for physiological pacing. Where are we now? J Am Coll Cardiol.2017; ( 69):3099-3114. DOI: https://doi.org/10.1016/j.jacc.2017.05.005

Healey JS, Toff WD, Lamas GA, Anderson HR, Thorpe KE, Ellenbogen KA, et al . Cardiovascular outcomes with atrial- based pacing compared with ventricular pacing: meta-analysis of randomized trials, using individual patient data .Circulation 2006; (114):11-7. DOI: https://doi.org/10.1161/CIRCULATIONAHA.105.610303

Mond GH, The road to right ventricular septal pacing: technique and tools. PACE 2010; (33):888-898. DOI: https://doi.org/10.1111/j.1540-8159.2010.02777.x

Shimony A, Eisenberg MJ, Filion KB, Amit G. Beneficial effects of right ventricular non-apical vs. apical pacing: a systematic review and meta-analysis of randomized-controlled trials. Europace 2012 (14):81-91. DOI: https://doi.org/10.1093/europace/eur240

Sharma PS, Dandamudi G, Naperkowski A, Oren JW, Storm RH, Ellenbogen KA, Vijayaraman P. Permanent His –bundle pacing is feasible , safe, and superior to right ventricular pacing in routine clinical practice. Heart Rhythm. 2015; 12(2):305-311. DOI: https://doi.org/10.1016/j.hrthm.2014.10.021

Dandamudi G, Vijayaraman P, How to perform permanent His bundle pacing in routine clinical practice. Heart Rhythm. 2016; (13):1362-1366. DOI: https://doi.org/10.1016/j.hrthm.2016.03.040

Abdulrahman M, Subzposh FA, Beer D. Clinical outcomes of Permanent His bundle pacing compared to right ventricular pacing. J Am Coll Cardiol .2018;71(20): 2319-2330 DOI: https://doi.org/10.1016/j.jacc.2018.02.048

Occhetta E, Bortnik M, Magnani A, Francalacci G, Piccinino C, Plebani L, Marino P. Prevention of ventricular desynchronization by permanent para-Hisian pacing after atrioventrcular node ablation in chronic atrial fibrillation: A cross over, blinded, randomized study versus apical right ventricular pacing. J Am Coll Cardiol .2006; 47(10):1938-1945. DOI: https://doi.org/10.1016/j.jacc.2006.01.056

Scherlag BJ, Kosowsky B, Damato A. A technique for ventricular pacing from the His bundle of the heart. J Appl Physiol 1967; (22):584-9. DOI: https://doi.org/10.1152/jappl.1967.22.3.584

Deshmukh P, Casavant DA, Romanyshyn M, Anderson K. Permanent direct His bundle pacing: a novel approach to cardiac pacing in patients with normal His-Purkinje activation. Circulation 2000; (101):869-77. DOI: https://doi.org/10.1161/01.CIR.101.8.869

Lustgarten DL, Calame S, Crespo EM, Calame J, Lobel R, Spector PS .Electrical resynchronization induced by direct His-bundle pacing. Heart Rhythm .2010;7(1):15-21. DOI: https://doi.org/10.1016/j.hrthm.2009.09.066

Vijayaraman P, Naperkowski A, Subzposh FA, Abdulrahman M, Sharma PS, Oren JW et al. Permanent His bundle pacing : long term lead performance and clinical outcomes. Heart Rhythm 2018; (15):696-702. DOI: https://doi.org/10.1016/j.hrthm.2017.12.022

Sharma PS, Dandamudi G, Herweg B, Wilson D, Singh R, Naperkowski A. Permanent His bundle pacing as an alternative to biventricular pacing for cardiac resynchronization therapy: a multicenter experience. Heart Rhythm. 2018; 15(3): 413-420. DOI: https://doi.org/10.1016/j.hrthm.2017.10.014

Ajijola OA, Upadhyay GA, Macias C, Shivkumar K, Tung ,R. Permanent His-bundle pacing for cardiac resynchronization therapy: initial feasibility study in lieu of left ventricular lead. Heart Rhythm. 2017; 14 (9): 1353-1361. DOI: https://doi.org/10.1016/j.hrthm.2017.04.003

Lustgarten DL, Crespo EM ,Arkipova –Jenkins I, Lobel R, Winget J, Koehler J, Liberman E, Sheldon T, His bundle pacing versus biventricular pacing in cardiac resynchronization therapy patients : a crossover design comparison. Heart Rhythm .2015; (12):1548-1557. DOI: https://doi.org/10.1016/j.hrthm.2015.03.048

Lustgarten DL. Step – wise approach to His Bundle pacing .The J of Innovation in Card Rhythm Management, 2016;(7) 2313-2321. DOI: https://doi.org/10.19102/icrm.2016.070402

Upadhyay GA, Tung R. Selective versus non- selective His bundle pacing for cardiac resynchronization therapy. J Electrocardiol.2017; 50(2):191-194 . DOI: https://doi.org/10.1016/j.jelectrocard.2016.10.003

Vijayaraman P, Sharma PS, Koneru JN, Dandamudi G . Chronic bundle branch blocks are due to logitudinal dissociation in the main His bundle : electrophysiologic observations from correction of BBB by permanent His bundle pacing .Heart Rhythm Society 2015 Scientific Sessions ;May 13, 2015;Boston, MA/ Abstract PO01-117.

Vijayaraman P, Naperkowski A, Lustgarten DL, Dandamudi G . Long term effects of permanent His bundle pacing: are there any adverse effects on distal His-Purkinje conduction? Heart Rhythm Society 2015 Scientific Sessions; May 13, 2015 Boston, MA Abstract PO01-111.

Aditya S, Nicholas J Serafini, Shawn Campbell, William B Waughet, Ryan Zimberg, Todd J. Sheldon et al. Novel Method for assessment of His Bundle pacing morphology using near field and far field device Electrograms. Circulation Arr and Elect 2019, Vol 12, issue 2, Feb. 1, 2019:1-11. DOI: https://doi.org/10.1161/CIRCEP.118.006878

Published

2020-09-21

How to Cite

1.
Alhamdi A. HIS BUNDLE PACING, THE FIRST EXPERIENCE USING A CONVENTIONAL PACEMAKER LEADS. JSMC [Internet]. 2020 Sep. 21 [cited 2024 Jul. 19];10(2):229-36. Available from: https://jsmc.univsul.edu.iq/index.php/jsmc/article/view/jsmc-10262

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