Imaging-Based Localization of His Bundle Pacing Electrodes: Results From the Prospective IMAGE-HBP Study

Pugazhendhi Vijayaraman; Gopi Dandamudi; Faiz A Subzposh; Richard K Shepard; Gautham Kalahasty; Santosh K Padala; John S Strobel; Terry D Bauch; Kenneth A Ellenbogen; Tracy Bergemann; Lisa Hughes; Megan L Harris; Dedra H Fagan; Zhongping Yang; Jayanthi N Koneru; IMAGE-HBP Investigators

doi:10.1016/j.jacep.2020.07.026

Imaging-Based Localization of His Bundle Pacing Electrodes: Results From the Prospective IMAGE-HBP Study

JACC Clin Electrophysiol. 2021 Jan;7(1):73-84. doi: 10.1016/j.jacep.2020.07.026. Epub 2020 Sep 30.

Authors

Affiliations

¹ Geisinger Heart Institute, Wilkes-Barre, Pennsylvania, USA. Electronic address: pvijayaraman1@geisinger.edu.
² Division of Cardiology, Division of Cardiac Electrophysiology, Indiana University, Indianapolis, Indiana, USA.
³ Geisinger Heart Institute, Wilkes-Barre, Pennsylvania, USA.
⁴ Department of Cardiology, Division of electrophysiology Virginia Commonwealth University, Richmond, Virginia, USA.
⁵ Medtronic, Inc., Mounds View, Minnesota, USA.

PMID: 33478715
DOI: 10.1016/j.jacep.2020.07.026

Abstract

Objectives: This study sought to evaluate the correlation between His bundle (HB) pacing (HBP) implantation characteristics, lead-tip location, and association of intraprocedural His recordings with approximated HB anatomic landmarks using computed tomography (CT) imaging.

Background: HBP continues to grow in clinical practice due to offering true physiological pacing. However, a clear understanding of HB anatomy and the lead-tip location's influence on pacing characteristics is lacking.

Methods: The IMAGE-HBP study (Imaging Study of Lead Implant for His Bundle Pacing) was a prospective, multicenter study designed to assess implantation characteristics of the SelectSecure Model 3830 lead placed at the HB, evaluate protocol-specified HBP success (His recording present on electrogram and HBP threshold ≤2.5 V at 1 ms), and correlation between lead-tip location by CT imaging and HBP characteristics as well as lead-related complications through 12 months.

Results: Sixty-nine patients underwent a lead implantation attempt at the HB. Of these, 61 patients (88%) had a lead successfully implanted at the HB, and 52 patients (75%) met the pre-specified definition of successful HBP. In 51 patients with CT imaging, 11 leads (22%) were placed in the atrial aspect of the HB region (36% selective HBP), and 40 leads (78%) were placed in the ventricular aspect (28% selective HBP). Four of the 51 patients had P-wave oversensing, all with leads in the atrium. Freedom from lead-related complication at 12 months was 93%.

Conclusions: Successful HBP could be achieved at lead-tip locations in the atrium or ventricle but is preferable in the ventricle to eliminate risk of oversensing. The IMAGE-HBP study offers better insight into approximated HB anatomic landmarks, lead-tip location, and correlation with pacing characteristics. (Imaging Study of Lead Implant for His Bundle Pacing [IMAGE-HBP]; NCT03294317).

Keywords: CT imaging; His bundle pacing; complications; nonselective HBP; selective HBP.

Publication types

Multicenter Study
Research Support, Non-U.S. Gov't

MeSH terms

Bundle of His* / diagnostic imaging
Cardiac Pacing, Artificial*
Electrodes
Humans
Prospective Studies
Treatment Outcome

Associated data

ClinicalTrials.gov/NCT03294317