D-PO02-096 - His Bundle Pacing Made Simple: A Standard Approach (ID 201)
G. Vanerio: Nothing relevant to disclose.
Background: His bundle pacing (HBP) should be the first option of ventricular stimulation. However; the procedure is more complex, requires special and expensive tools, the lead could develop higher thresholds, and it may take a longer time compared to standard pacing.
Objective: Describe an easier technique to achieve nonselective HBP
Methods: We studied 46 consecutive patients from our service with a class 1A permanent pacemaker indication. We performed a standard implantation technique, using the left axillar - subclavian approach. We utilized an active fixation lead 52 or 58 cm, (Medtronic 5076 CapSureFix Novus or Abbott Tendril 2088TC lead). Before the implant, we curved the guidewire in order to obtain a double twist to direct the lead close to the His bundle area. Using RAO and LAO views; the lead was positioned, and a 12 lead ECG was performed during pacing in order to observe and measure the QRS interval. If acceptable (≤130 ms) it was fixed, if not, it was moved to another location. QRS duration was measured in D2 and V6 pre and post-implant and compared.
Results: In 43/46 patients we achieved an adequate QRS interval duration, in the vast majority of cases nonselective HBP, pre implant QRS was 112 ± 33 ms versus 121 ± 21 ms, (p = 0.11). There were no complications and R wave and ventricular capture threshold were within normal values (< 1.5 V @ 0.4 ms) in all patients. Procedure time was not prolonged.
Conclusion: Using a standard technique; with a modified guidewire curve we can achieve nonselective HBP in the majority of patients avoiding specific, expensive tools.