Background: Despite considerably promising merits, challenges with His bundle pacing (HBP) still remain, particularly in patients with enlarged cardiac chambers and advanced conduction disease.
Objective: To assess the feasibility and outcomes of distal His bundle region pacing (DHBRP) by tricuspid valve annulus (TVA) angiography in challenging HBP implants.
Methods: Thirty challenging HBP implants were recruited. Among them, fifteen underwent DHBRP by TVA angiography and another 15 underwent conventional HBP. Challenging HBP implants were defined as the HBP under conventional fluoroscopy not be achieved after a His lead fluoroscopy time of 15 minutes. Success rate, pacing parameters and echocardiographic data were assessed perioperatively and at 3-month follow-up.
Results: In conventional group, HBP was successfully achieved in 5 of 15 patients, compared with the DHBRP group achieved in 12 of 15 patients. The success rate in DHBRP group was significantly higher than that in conventional group (80.0% vs. 33.3%, P=0.025). The His bundle capture threshold and R-wave amplitude of DHBRP group were 1.66 ± 0.56 V/1.0ms and 5.5 ± 1.3 mV at implant and remained stable during 3-month follow-up without procedure-related complications and tricuspid valve function affected. Cardiac function and left ventricular synchrony in DHBRP group at 3-month follow-up were significantly improved compared with that at baseline.
Conclusion: Permanent DHBRP is feasible and safe, resulting in a significant higher success rate in challenging HBP implants compared with conventional HBP.