A feasible approach for direct his-bundle pacing using a new steerable catheter to facilitate precise lead placement

J Cardiovasc Electrophysiol. 2006 Jan;17(1):29-33. doi: 10.1111/j.1540-8167.2005.00285.x.

Abstract

Introduction: Much clinical evidence has shown that right ventricular (RV) apical pacing is detrimental to left ventricular function. Preservation of the use of the His-Purkinje (H-P) system may be ideal in heart block that is restricted to the AV node, but may be of no benefit when H-P disease exists.

Aim: To investigate the feasibility of direct His-bundle pacing (DHBP) using a new system consisting of a steerable catheter and a new 4.1 F screw-in lead.

Method: Between May and December 2004, 26 patients (19 male, mean age: 77 +/- 5 years) with a standard pacemaker (PM) indication and preserved His-bundle conduction were enrolled and DHBP was attempted.

Results: DHBP was achieved in 24 patients (92%); two patients were paced in the His area, but the paced QRS morphology and duration were different from the native QRS. The mean time for lead positioning was 19 +/- 17 minutes, the mean fluoroscopy time was 11 +/- 8 minutes, and the total procedure time (skin-to-skin including positioning of a quadripolar diagnostic catheter for His recording) was 75 +/- 18 minutes. In DHBP pacing, the acute pacing threshold was 2.3 +/- 1.0 V at a pulse duration of 0.5 msec, and the sensed potentials were 2.9 +/- 2.0 mV. At a 3-month follow-up examination, the same QRS duration and morphology recorded on implantation were observed in all patients. The pacing threshold was 2.8 +/- 1.4 V, and sensed potentials were 2.5 +/- 1.8 mV; the sensing configuration was changed from bipolar to unipolar in 6 patients to resolve undersensing issues. No major complications were observed.

Conclusions: This feasibility study shows that DHBP can be accomplished with a new system consisting of a steerable catheter and an active fixation lead in 92% of the patients in whom it was attempted.

Publication types

  • Comparative Study
  • Evaluation Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Bundle of His / physiopathology*
  • Cardiac Pacing, Artificial / methods*
  • Electrocardiography
  • Electrodes
  • Equipment Design
  • Feasibility Studies
  • Female
  • Fluoroscopy
  • Follow-Up Studies
  • Heart Block / diagnostic imaging
  • Heart Block / physiopathology
  • Heart Block / therapy*
  • Humans
  • Male
  • Pacemaker, Artificial*
  • Retrospective Studies
  • Treatment Outcome