Novel implant technique for septal pacing. A noninvasive approach to nonselective his bundle pacing

Abstract

Background: His Bundle pacing (HBP) preserves native ventricular activation through His Purkinje. Unfortunately, most current techniques for HBP implants require sheaths, special leads, and an electrophysiology setup for electrogram recording.

Methods: We developed an implantation technique guided by a non-invasive assessment of left ventricular electrical delay (LVED) as a measure of intraventricular dyssynchrony. The objective was to evaluate the usefulness and safety of this technique for implants of pacemakers and ICDs with right ventricular septal pacing (RVSP) using conventional screw-in leads and compare it with a reduced group of HBP (n = 32) guided by His potential mapping. 208 patients eligible for ventricular stimulation were implanted. Conventional screw-in leads were used in all cases. To ensure mechanical stability, stylets required a slight reshaping at the tip RESULTS: RVSP normalized electrical activity in patients with conduction disease, producing NS-HBP-like patterns. The parameters evaluated during implantation for the RVSP group were better than those of HBP and remained constant at a twelve months follow-up. In proportion, the number of dislodgments and the need for CRT upgrade was lower for RVSP than for HBP. Additionally, fluoroscopy time was significantly reduced in the RVSP group.

Conclusions: This technique successfully guided RVSP implants in a non-invasive way and represents a simple alternative to the implant of a cardiac stimulation device.

Keywords: Cardiac stimulation device; Implantation technique; Left ventricular electrical delay; Non-selective his bundle pacing; Right ventricular septal stimulation.