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

D-PO02-085 - Can Chronic His Bundle Pacing Be Safely Started In Centers With Lack Of Experience Of This Technique? Data From A French Multicentric Registry (ID 199)

  F. Anselme: Honoraria/Speaking/Consulting Fee - Boston Scientific; Medtronic; MicroPort CRM.


Background: Right ventricular pacing (RVP) induces ventricular asynchrony in patients with normal QRS and increases the risk of heart failure and atrial fibrillation on long term. His bundle pacing (HBP) is a physiological alternative to RVP. Interest in HBP has been hampered in part by technical challenges and limited implantation tool set. Recent studies assessed feasibility and safety of HBP in expert centers with a vast experience of this technique. These results may not apply to less experienced centers.
Objective: To evaluate feasibility and safety of permanent His bundle pacing in hospitals with limited technical training to this technique.
Methods: We included all patients who underwent pacemaker implantation with attempt of HBP in 3 hospitals between September 2017 and November 2019. All the 6 operators were novice for HBP. Selective His bundle capture (HBC) was defined as concordance of QRS and T waves complexes with the native ECG (patients with underlying bundle branch block may normalize), presence of a delay between spike and QRS complex, absence of widening of the QRS at a low pacing output, and recordable His bundle electrogram. At 3 and 12 months follow-up, HBC thresholds were recorded.
Results: HPB was successful in 105 of 120 patients (87.5%); selective HBC was obtained in 79 patients (75.2%) while nonselective HBC occurred in 26 patients (24.8). Indication for pacemaker implantation was atrioventricular conduction disease in 63 patients, sinus node dysfunction in 17 and AV nodal ablation for non-controlled atrial arrhythmias in 40. The mean procedure duration was 66±5min, and mean fluoroscopy duration was 7.4±1.4min (2.75±0.58Gy.cm2). The mean HBC threshold was 1.33±0.18V@0.5ms and did not increase at 3 months (1.29±0.24V@0.5ms) and 12 months (1.32±0.32V@0.5ms) follow-up. Bundle branch block correction was achieved in 6 of 9 patients with underlying left bundle branch block. Ventricular lead revision was required at 3 months in one patient for sudden threshold increase, without obvious lead dislodgement and at 1 month in one patient for lead dislodgement. There was no pericardial effusion, no pneumothorax and no device infection.
Conclusion: His bundle pacing performed by novice operators to this technique appeared feasible and safe.