Bundle of his pacing

BACKGROUND: There has been recent growing interest in the use of conduction system pacing (CSP) for both bradycardia and heart failure indications. There remains a paucity of data, however, regarding complications related to the intraventricular septum associated with CSP implant and the management of these events. CASE SUMMARY: We present a case of a patient with non-ischemic dilated cardiomyopathy presenting for cardiac resynchronization therapy in whom left bundle branch area pacing was complicated with interventricular septal perforation and managed intra-procedurally with repositioning of the lead to provide His bundle pacing (HBP) for QRS correction of underlying left bundle branch block...

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Conduction system pacing involving either His bundle pacing (HBP) or left bundle branch pacing (LBBP) is a modality that has been introduced as a safe and effective alternative to right ventricular (RV) pacing to help prevent pacemaker-associated cardiomyopathy. While HBP has been employed in the pediatric and congenital populations, several small studies have shown LBBP to be safe and effective in the pediatric population. We present a patient with congenital atrioventricular block and postoperative ventricular septal defect repair cardiomyopathy with subsequent left ventricular function improvement following a transition from an RV epicardial pacemaker system to an LBBP system...

INTRODUCTION: The optimal slow pathway (SP) ablation site in cases with an inferiorly located His bundle (HIS) remains unclear. METHODS AND RESULTS: In 45 patients with atrioventricular nodal reentrant tachycardia, the relationship between the HIS location and successful SP ablation site was assessed in electroanatomical maps. We assessed the location of the SP ablation site relative to the bottom of the coronary sinus ostium in the superior-to-inferior (SPSI), anterior-to-posterior (SPAP), and right-to-left (SPRL) directions...

Conduction system pacing (CSP) has emerged as a promising alternative to biventricular pacing (BVP) heart failure patients with reduced ejection fraction (HFrEF) and ventricular dyssynchrony, but its benefits are still uncertain. In this study, we aim to evaluate clinical outcomes of CSP versus BVP for cardiac resynchronization in patients with HFrEF. PubMed, Scopus, and Cochrane databases were searched for randomized controlled trials (RCTs) comparing CSP to BVP for resynchronization therapy in patients with HFrEF...

BACKGROUND: Heart failure patients with non-left bundle branch block (non-LBBB) QRS pattern have limited response rate to biventricular pacing (BVP). OBJECTIVES: A personalized cardiac resynchronization therapy (CRT) implantation approach guided by real-time electrocardiographic imaging (ECGi) was studied. METHODS: Twenty patients with left ventricular ejection fraction (LVEF) ≤35%, QRS duration ≥120ms and non-LBBB (13 right bundle branch block and 7 intraventricular conduction delay) were recruited...

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INTRODUCTION: Clinical outcomes of long-term ventricular septal pacing (VSP) without His-Purkinje capture remain unknown. This study evaluated the differences in clinical outcomes between conduction system pacing (CSP), VSP, and right ventricular pacing (RVP). METHODS: Consecutive patients with bradycardia indicated for pacing from 2016 to 2022 were prospectively followed for the clinical endpoints of heart failure (HF)-hospitalizations and all-cause mortality at 2 years...

BACKGROUND: Metabolic disorder is noted for pacing-induced cardiomyopathy. The benefits of His bundle pacing over right ventricular (RV) pacing in preventing pacing-induced cardiomyopathy from a metabolic perspective are yet to be fully understood. METHOD AND RESULTS: Three pig groups were established for this study: sham control, RV pacing (RV pacing for 6 months), and His pacing (RV pacing for 6 months, followed by His bundle pacing for 3 months)...

BACKGROUND: Fluoroscopy is conventionally performed for cardiac implantable electronic device (CIED) therapy and carries radiation drawback for both patients and medical workers. Recently, zero to minimal fluoroscopy (ZMF) approach is introduced to reduce radiation exposure of fluoroscopy. This study compares the feasibility and safety of ZMF approach to fluoroscopy for CIEDs therapy in adults. METHOD: A systematic literature search was conducted on PubMed, ScienceDirect, and Web of Science in March 2023...

BACKGROUND: In heart failure with preserved ejection fraction (HFpEF), it has been assumed that pharmacologic heart rate suppression should provide clinical benefits through an increase in diastolic filling time. Contrary to this assumption, heart rate lowering in patients with preserved left ventricular ejection fraction and hypertension or coronary artery disease results in adverse outcomes and suggests that the opposite may be beneficial. Namely, shortening the diastolic filling time with a higher heart rate might normalize the elevated filling pressures that are the sine qua non of HFpEF...

BACKGROUND: Conduction system pacing (CSP), either as His bundle pacing (HBP) or as left bundle branch area pacing (LBBAP), may be superior to right ventricular apical or septal pacing. OBJECTIVE: The study sought to present acute results for a new guiding catheter (Biotronik Selectra 3D) designed for CSP implantations of a retractable screw-in lead (Biotronik Solia S). METHODS: The primary endpoint of the prospective, international nonrandomized BIO|MASTER...

Right bundle branch block (RBBB) and resulting RV electromechanical discoordination are thought to play a role in the disease process of subpulmonary right ventricular (RV) dysfunction that frequently occur post-repair tetralogy of Fallot. We sought to describe this disease entity, the role of pulmonary re-valvulation and the potential added value of RV cardiac resynchronization therapy (RV-CRT). Two patients with repaired tetralogy of Fallot, complete right bundle branch block, pulmonary regurgitation and significantly decreased RV function underwent echocardiography, cardiac magnetic resonance, and an invasive study to evaluate the potential for RV-CRT as part of the management strategy...

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BACKGROUND: Conduction system pacing (CSP) is increasingly utilized to prevent and correct dyssynchrony. Barriers to CSP adoption include limited training, methodologic variability, laboratory slot allocation, and few data on learning curves. We report learning curves/clinical outcomes from a single experienced electrophysiologist who was new to CSP, and share gained insights. METHODS: Retrospective analysis of all patients who underwent attempted CSP implantation (2016-2023)...

BACKGROUND: The primary prerequisite for a successful conduction system pacing (CSP) procedure is the integrity of the conduction system, which may be impaired if a baseline bundle branch block (BBB) is present. This study aimed to evaluate the feasibility and mid-term performance of permanent CSP in patients with baseline BBB and to compare the results between left bundle branch block (LBBB) and right bundle branch block (RBBB) patterns. MATERIAL AND METHODS: A total of 101 patients with typical BBB and an attempt at CSP were retrospectively reviewed...

BACKGROUND: Holt-Oram syndrome (HOS) is a rare genetic illness, which concerns disturbances in the appearance of the upper limbs, congenital heart malformations, and cardiac conduction diseases. HOS usually requires the implantation of a pacemaker, because of cardiac conduction disturbances. CASE REPORT: We present the case of a patient with HOS qualified for pacemaker implantation due to overt bradycardia. To prevent the development of heart failure in the future, the His-bundle pacing technique was used...

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We performed cardiac resynchronization therapy by means of conduction system pacing in a heart transplant patient suffering from heart failure with reduced ejection fraction and atrial fibrillation with conduction disturbance (bifascicular block and QRS >160ms). ECG monitoring showed paroxysmal atrioventricular block. Biventricular pacing was not feasible due to the absence of a suitable coronary sinus branch for pacing. His bundle pacing was performed, and an implantable cardioverter-defibrillator was implanted due to severe left ventricular dysfunction...

Cardiac pacing has been an established therapy for bradyarrhythmia due to sinus or atrioventricular nodal disease since the 1950s. However, contemporary studies have shown that conventional right ventricular pacing (RVP) causes electromechanical dyssynchrony, which can lead to atrial fibrillation, heart failure and even death. Recently, the push for a more physiological cardiac pacing has seen a revival in the utilisation and development of conduction system pacing (CSP). There has been a shift towards adopting His bundle pacing (HBP) or left bundle branch area pacing (LBBaP) in bradycardia patients worldwide and in Singapore...