Cardiovascular Implantable Electronic Devices -> Leads & Electrodes: -> Implantation D-PO04 - Poster Session IV (ID 15) Poster

D-PO04-092 - Impact Of Sub-valvular Lead Tip Position On Qrs And Echocardiographic Indices Among Patients Undergoing His Bundle Pacing (ID 1189)


Background: Although His bundle pacing (HBP) lead position may be atrial or sub-valvular, the location of the lead tip and impact on QRS or echocardiographic indices remains uncertain.
Objective: The purpose of this study was to asses HBP lead tip position and impact on QRS width, ventricular function, and tricuspid regurgitation.
Methods: Consecutive HBP patients (2016-2019) with paired transthoracic echocardiographic data were retrospectively analyzed. HBP lead tip was localized as sub-valvular or atrial using 4-chamber and RV inflow views (see Figure). QRS was assessed measuring the intrinsicoid deflection-to-QRS end. Change in left ventricular ejection fraction (LVEF) and tricuspid regurgitation were also evaluated.
Results: Sixty-eight patients were studied: 35% female, 72±14 yrs, with 33 (49%) receiving cardiac resynchronization therapy (CRT) devices. Mean LVEF was 42±17% and baseline QRS was 137±35 ms. Final HBP lead tip position was sub-valvular in 53 (78%), atrial in 14 (21%), and indeterminate in 1 (1%). There was no significant difference in baseline characteristics between sub-valvular and atrial HBP patients. Sub-valvular lead tip was associated with significantly improved QRS (138 ms [108-161] to 126 ms [106-134], p=0.003), and with greater QRS narrowing than in the atrial lead position (QRS 139 [98-168] to 123 [108-138], p=0.20). There were no significant differences in change in LVEF or tricuspid regurgitation between groups.
Conclusion: Subvalvular HBP lead position is common and was associated with significant improvement in QRS width, and with comparable improvements in LVEF and TR as patients with atrial HBP lead position.