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

D-PO02-095 - The Safety And Efficacy Of EAM-guided His-bundle Pacing (ID 1012)

 H. Patel: Nothing relevant to disclose.


Background: The safety and efficacy of EAM guided device implantation has been successfully shown in several pilot studies; however, its role in HIS bundle pacing has not been studied. Conventional HIS lead implantation with the use of fluoroscopy can be time consuming with variable rates of cumulative radiation for the operator, with variable success and an approximate failure rate of 27%.
Objective: We conducted a retrospective analysis of patients who underwent HIS lead implantation by one operator at Ascension Providence Hospital to evaluate the potential benefits of EAM guided HIS lead implantation.
Methods: Our study compared 17 patients who underwent HIS bundle pacing using the EAM guided technique with the NavX Mapping System to a control group of 19 patients who had HIS bundle pacing attempted using the conventional technique with standard fluoroscopy. In the EAM group: a quadripolar catheter was used to create an anatomic and navigational highway with accurate plotting of the Bundle of HIS. Subsequently a bipolar active fixation lead was connected to the NavX system to accurately guide its delivery to the bundle of HIS. Outcomes were measured including success of HIS pacing, procedure and fluoroscopy times and complications.
Results: Successful HIS bundle pacing was achieved in all 17 patients in the EAM guided group; whereas, success rate with conventional implantation was approximately 68%. Implantation times were initially similar in both groups; however, times in the EAM guided group showed improvement as the operator gained experience. Mean radiation dose was significantly lower in the EAM guided group (p < 0.05). No adverse events/complications were observed in either group intra-op, immediately post-operatively or at routine follow up at 4-6 weeks.
Conclusion: Our pilot study illustrates the benefit of using an electroanatomic navigation system (NavX system) for HIS lead implantation. Under EAM guidance, HIS lead implantation was more successful with no peri-operative or post-operative complications, including need for lead revisions. Radiation exposure was reduced and the steady improvement in procedure time illustrates a very favorable learning curve.