His pacing program: a 2-year single-centre experience. (24th May 2021) - Pasara, V
Abstract: Funding Acknowledgements: Type of funding sources: None. Background: His bundle pacing (HBP) physiologically activates the ventricles by a direct stimulation of the His-Purkinje cardiac conduction system. It was first described in the 1970s, and the initial feasibility studies were reported in the early 2000s. Later on, technological advances led to its widespread adoption and growing evidence base. Purpose: This retrospective study aimed to assess implant success rate, feasibility and safety of the His-bundle lead implantation program in our centre. Methods: All patients who underwent His-bundle lead implantation in our centre from the start of the HBP program in November 2018 until November 2020 were analyzed. Data were collected from existing hospital electronic medical records. Results: A total of 125 patients (64.8 % male, 65.1 ± 13.9 years) were included in the study. Nearly half of patients (47.2 %) had chronic heart failure and 39.2 % had atrial fibrillation. Indications for pacing included antibradycardia pacing (68.8 %) and cardiac resynchronization therapy (31.2 %). His-bundle lead was successfully implanted in 114 patients (91.2 % acute success), while the rest of the procedures were converted into right ventricle lead placement. 32.8 % of all patients had native narrow QRS complexes. Among patients who received HBP for cardiac resynchronization therapy, QRS duration was reduced from 177.5 ± 26.4 at baseline to 145.8 ± 23.9 after HBP (p < 0.001). However, QRS duration slightly prolonged in the antibradycardia group from 118.8 ± 31.9 at baseline to 130.4 ± 25.3 after HBP (p = 0.011). Seven (8.6 %) patients in the antibradycardia group had late lead disfunction/dislodgement and therefore underwent reoperation with the conventional right ventricle lead placement. Two patients (4.7 %) from the resynchronization group had inappropriate resynchronization response and underwent the conventional coronary sinus lead implantation. Only one patient (0.8 %) had a device-associated infection. Conclusion: Our data suggest that HBP is a feasible strategy of physiological pacing and resynchronization with an acceptable success and low complication rates. Our His-bundle implantation program results are similar to data available in the current literature.