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Europace : European Pacing,... Apr 2023Conduction system pacing (CSP) has emerged as a more physiological alternative to right ventricular pacing and is also being used in selected cases for cardiac...
EHRA clinical consensus statement on conduction system pacing implantation: endorsed by the Asia Pacific Heart Rhythm Society (APHRS), Canadian Heart Rhythm Society (CHRS), and Latin American Heart Rhythm Society (LAHRS).
Conduction system pacing (CSP) has emerged as a more physiological alternative to right ventricular pacing and is also being used in selected cases for cardiac resynchronization therapy. His bundle pacing was first introduced over two decades ago and its use has risen over the last five years with the advent of tools which have facilitated implantation. Left bundle branch area pacing is more recent but its adoption is growing fast due to a wider target area and excellent electrical parameters. Nevertheless, as with any intervention, proper technique is a prerequisite for safe and effective delivery of therapy. This document aims to standardize the procedure and to provide a framework for physicians who wish to start CSP implantation, or who wish to improve their technique.
Topics: Humans; Latin America; Canada; Heart Conduction System; Cardiac Conduction System Disease; Cardiac Resynchronization Therapy; Bundle of His
PubMed: 37061848
DOI: 10.1093/europace/euad043 -
Journal of the American College of... Aug 2018Traditional right ventricular (RV) pacing for the management of bradyarrhythmias has been pursued successfully for decades, although there remains debate regarding... (Review)
Review
Traditional right ventricular (RV) pacing for the management of bradyarrhythmias has been pursued successfully for decades, although there remains debate regarding optimal pacing site with respect to both hemodynamic and clinical outcomes. The deleterious effects of long-term RV apical pacing have been well recognized. This has generated interest in approaches providing more physiological stimulation, namely, His bundle pacing (HBP). This paper reviews the anatomy of the His bundle, early clinical observations, and current approaches to permanent HBP. By stimulating the His-Purkinje network, HBP engages electrical activation of both ventricles and may avoid marked dyssynchrony. Recent studies have also demonstrated the potential of HBP in patients with underlying left bundle branch block and cardiomyopathy. HBP holds promise as an attractive mode to achieve physiological pacing. Widespread adaptation of this technique is dependent on enhancements in technology, as well as further validation of efficacy in large randomized clinical trials.
Topics: Arrhythmias, Cardiac; Bundle of His; Bundle-Branch Block; Cardiac Pacing, Artificial; Cardiac Resynchronization Therapy; Cardiac Resynchronization Therapy Devices; Electrocardiography; Humans
PubMed: 30115232
DOI: 10.1016/j.jacc.2018.06.017 -
JACC. Clinical Electrophysiology Mar 2023Junctional tachycardia (JT) is typically considered to have an automatic mechanism originating from the distal atrioventricular node. When there is 1:1 retrograde... (Review)
Review
Junctional tachycardia (JT) is typically considered to have an automatic mechanism originating from the distal atrioventricular node. When there is 1:1 retrograde conduction via the fast pathway, JT would resemble the typical form of atrioventricular nodal re-entrant tachycardia (AVNRT). Atrial pacing maneuvers have been proposed to exclude AVNRT and suggest a diagnosis of JT. However, after excluding AVNRT, one should consider the possibility of an infra-atrial narrow QRS re-entrant tachycardia, which can exhibit features that resemble AVNRT as well as JT. Pacing maneuvers and mapping techniques should be performed to assess for infra-atrial re-entrant tachycardia before concluding that JT is the mechanism of a narrow QRS tachycardia. Distinguishing JT from typical AVNRT or infra-atrial re-entrant tachycardia has notable implications regarding the approach to ablation of the tachycardia. Ultimately, a contemporary review of the evidence on JT raises some questions as to the mechanism and source of what has traditionally been considered JT.
Topics: Humans; Atrial Fibrillation; Electrophysiologic Techniques, Cardiac; Tachycardia, Ectopic Junctional; Atrioventricular Node; Bundle of His; Tachycardia, Atrioventricular Nodal Reentry; Tachycardia, Supraventricular
PubMed: 36990601
DOI: 10.1016/j.jacep.2022.10.040 -
Circulation. Arrhythmia and... Feb 2019Although permanent His bundle pacing was first reported almost 2 decades ago, it is only recently gaining wider adoption, following facilitation of the implant procedure... (Review)
Review
Although permanent His bundle pacing was first reported almost 2 decades ago, it is only recently gaining wider adoption, following facilitation of the implant procedure by dedicated tools. An additional challenge is programming the system, as His bundle pacing may have specific configurations and require special considerations which current implantable pulse generators are not designed for. The aim of this article is to provide practical recommendations for programming His bundle pacing, to deliver optimal therapy and ensure patient safety.
Topics: Action Potentials; Arrhythmias, Cardiac; Bundle of His; Cardiac Pacing, Artificial; Electrocardiography; Electrophysiologic Techniques, Cardiac; Equipment Design; Heart Failure; Heart Rate; Humans; Pacemaker, Artificial; Predictive Value of Tests; Signal Processing, Computer-Assisted; Time Factors; Treatment Outcome
PubMed: 30722682
DOI: 10.1161/CIRCEP.118.006816 -
JACC. Clinical Electrophysiology Jan 2022
Topics: Bundle of His; Cardiac Catheterization; Cardiac Pacing, Artificial; Humans
PubMed: 35057980
DOI: 10.1016/j.jacep.2021.08.014 -
Indian Heart Journal 2016Adverse hemodynamics of right ventricular (RV) pacing is a well-known fact. It was believed to be the result of atrio-ventricular (AV) dyssynchrony and sequential pacing... (Review)
Review
Adverse hemodynamics of right ventricular (RV) pacing is a well-known fact. It was believed to be the result of atrio-ventricular (AV) dyssynchrony and sequential pacing of the atrium and ventricle may solve these problems. However, despite maintenance of AV synchrony, the dual chamber pacemakers in different trials have failed to show its superiority over single chamber RV apical pacing in terms of death, progression of heart failure, and atrial fibrillation (AF). As a consequence, investigators searched for alternate pacing sites with a more physiological activation pattern and better hemodynamics. Direct His bundle pacing and Para-Hisian pacing are the most physiological ventricular pacing sites. But, this is technically difficult. Ventricular septal pacing compared to apical pacing results in a shorter electrical activation delay and consequently less mechanical dyssynchrony. But, the study results are heterogeneous. Selective site atria pacing (atrial septal) is useful for patients with atrial conduction disorders in prevention of AF.
Topics: Atrial Fibrillation; Bundle of His; Cardiac Pacing, Artificial; Electrocardiography; Hemodynamics; Humans
PubMed: 27543481
DOI: 10.1016/j.ihj.2016.03.033 -
JACC. Clinical Electrophysiology Jan 2022
Topics: Bundle of His; Bundle-Branch Block; Humans
PubMed: 35057981
DOI: 10.1016/j.jacep.2021.08.007 -
Journal of Cardiovascular... Jun 2020Left bundle branch pacing (LBBP) is a promising new method for patients with pacing indications. This study aims to evaluate the safety and feasibility of LBBP in a... (Observational Study)
Observational Study
INTRODUCTION
Left bundle branch pacing (LBBP) is a promising new method for patients with pacing indications. This study aims to evaluate the safety and feasibility of LBBP in a relatively longer time span.
METHODS AND RESULTS
A total of 164 patients were recruited for LBBP in this study. Among these patients, 148 patients had pacing indications due to symptomatic bradycardia while the other 16 patients had indications for cardiac resynchronization therapy (CRT). LBBP was successful in 89.0% (146/164) of all recruited patients. Intracardiac and surface electrographic parameters and image data were documented during the LBBP procedure. The mean paced QRS duration (pQRSD) and the mean stimulus to left ventricular activation time (stim-LVAT) was 106.0 ± 12.9 ms and 64.4 ± 13.7 ms respectively. Left bundle branch (LBB) potentials were recorded in 89 patients. Forty-three of whom had sick sinus syndrome (SSS), and 46 had atrioventricular block (AVB). The presence of LBB potential was more common in patients with SSS (82.7% vs 57.5%, P = .002). No significant differences in pQRSD, stim-LVAT, or capture threshold were detected between patient groups with or without LBB potential. Patients were followed up at 1 month, 3 months, 6 months, and 1 year after the procedure. Pacing parameters and the echocardiographic data remained stable within a mean follow-up period of 8.6 ± 4.3 months. No serious complication caused by this procedure was found in this study.
CONCLUSIONS
Successful LBBP carried an aspect of short pQRSD and stim-LVAT while the LBB potential was not the prerequisite and necessary feature. The LBBP procedure had a high success rate with satisfied and stable lead parameters during short and intermediate-term observations.
Topics: Action Potentials; Adolescent; Adult; Aged; Aged, 80 and over; Arrhythmias, Cardiac; Bundle of His; Cardiac Pacing, Artificial; China; Feasibility Studies; Female; Heart Rate; Humans; Male; Middle Aged; Prospective Studies; Risk Assessment; Risk Factors; Time Factors; Treatment Outcome; Young Adult
PubMed: 32239598
DOI: 10.1111/jce.14463 -
Arquivos Brasileiros de Cardiologia Jan 2021
Topics: Bundle of His; Catheter Ablation; Humans; Tachycardia, Atrioventricular Nodal Reentry; Tachycardia, Supraventricular
PubMed: 33566976
DOI: 10.36660/abc.20201149 -
Annals of Noninvasive Electrocardiology... Apr 2012The success rate of direct His bundle pacing (DHBP) and paraHisian pacing has improved remarkably in the last 3-5 years with the advent of dedicated fixation systems... (Review)
Review
The success rate of direct His bundle pacing (DHBP) and paraHisian pacing has improved remarkably in the last 3-5 years with the advent of dedicated fixation systems that have reduced procedural duration, dislodgement rate, and fluoroscopy time. The methodology of DBHP remains still more complex than paraHisian pacing and is associated with high-pacing thresholds. Thus, DHBP entails greater battery current drain and reduced device longevity. A shift toward paraHisian pacing (which is fusion pacing of myocardium and His bundle) has occurred because its implementation is easier and the electrical parameters are superior to those of DBHP. Currently, an additional safety lead is inserted at the RV apex or outflow tract to prevent asystole, especially in patients with pure DHBP. It is often possible to avoid a safety lead with paraHisian pacing because ventricular pacing is virtually assured on a long-term basis via myocardial capture. DBHP and paraHisian pacing can be achieved in a substantial proportion of patients with varying grades of narrow QRS AV block or after AV junctional ablation and in some patients with the ECG manifestation of bundle branch block caused by an intraHisian lesion. Preliminary observations suggest that DHBP may be useful in some patients requiring cardiac resynchronization if it produces a narrow QRS complex because the site of an intraHisian lesion responsible for left bundle branch block is above the site of DHBP.
Topics: Bundle of His; Bundle-Branch Block; Cardiac Pacing, Artificial; Electrocardiography; Fluoroscopy; Hemodynamics; Humans; Pacemaker, Artificial
PubMed: 22537323
DOI: 10.1111/j.1542-474X.2012.00488.x