Cardiovascular Implantable Electronic Devices -> Bradycardia Devices: -> Device Technology D-PO02 - Poster Session II (ID 47) Poster

D-PO02-092 - His Bundle Pacing Device Algorithms Are Needed For Effective Capture And Sensing: A Multi-center Clinical Experience (ID 1010)

Abstract

Background: His Bundle pacing (HBP) has been adopted as a more physiologic pacing therapy. However, traditional implantable pulse generators (IPGs) were used without supporting algorithms for HBP.
Objective: To assess a multi-center clinical experience with the usage of IPGs for HBP and to identify the needs for HBP device algorithms.
Methods: Patients from 7 centers worldwide with a permanent HBP lead and an Abbott IPG were enrolled. Device data were collected at a follow-up visit. HBP capture types were adjudicated using 12-lead ECG. Bundle branch block (BBB) correction by HBP was defined as QRS duration ≤130 ms or narrowing by >20%. Atrial and ventricular components on the HB EGMs from both unipolar and bipolar sensing were measured. Atrial component ≥ 0.5 mV on HB EGMs were considered with risk of atrial oversensing.
Results: A total of 153 patients (75±10 yrs, 101 male, 46% AV block, 38% BBB, 25% SSS, LVEF 49±13) completed data collection post implant (median: 44, range: 0-3110 days). The distribution of IPGs was SR 5%, DR pacer 67%, CRT-P 8%, and CRT-D 20%. DR pacer with an atrial lead and a HB lead connected to V port was the most popular (64%) system. In non-BBB patients, pacing thresholds for selective HB (n=49), non-selective HB (n=60), and myocardial capture (n=32) were 1.5±1.2, 3.0±2.1, 1.3±1.2 V, respectively, at pulse width of 0.8±0.4 ms. In BBB patients, LBBB and RBBB were corrected in 14/30 (47%) and 12/28 (43%) patients with pacing thresholds of 3.5±2.2 and 2.1±2.0 V, respectively, at pulse width of 0.8±0.3 ms. AutoCapture™ algorithm was tested in 66 patients and recommended to be OFF in 29 (44%) patients. A risk of atrial oversensing was identified in 22/92 (22%) and 33/98 (34%) patients during bipolar and unipolar sensing, respectively, and in 13/91 (14%) patients during both configurations. The average atrial and ventricular amplitudes on the HB EGM were 0.9±0.4, 4.9±4.6 mV during bipolar and 0.7±0.3, 5.3±4.9 mV during unipolar sensing, respectively. Nine (9%) patients had A/V ratio higher than 0.5.
Conclusion: Various device configurations are used for HBP. HBP presents unique challenges in capture management and sensing beyond traditional RV pacing. HBP specific device algorithms are needed to ensure correct IPG usage and facilitate device programming.
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