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

D-PO04-101 - Intracardiac Echo Guided His Bundle Lead Implantation: A Simple And Reproducible Method To Facilitate Successful Implantation (ID 438)


Background: Finding a suitable pacing site for His Bundle Lead Implantation (HBLI) can be challenging. The His bundle is located along the inferior aspect of the membranous septum which can be imaged using intracardiac echo (ICE).
Objective: Evaluate the efficacy and safety of ICE in guiding HBLI.
Methods: Patients who underwent HBLI between 1/1/17 and 12/1/19 were included. ICE guided HBLI formed the study group (G1), while those undergoing conventional fluoroscopically guided HBLI formed the control group (G2). G1 patients underwent an additional axillary vein puncture and placement of a 9 Fr sheath through which an ICE catheter was passed to the RA where medial rotation imaged the membranous septum (Figure). A His sheath and lead were then advanced to the membranous septum based on ICE images. A His deflection was consistently recorded here. Small movements were then used to optimize pacing before fixation.
Results: 38 patients underwent HBLI (G1=18 and G2=20). There was no significant difference between G1 and G2 in gender, age (73.9 ± 11.7 vs. 71.3 ± 9.9 years), and ejection fraction (49.4 ± 10.1 vs. 49.1 ± 13.4) respectively. Fluoroscopy times were shorter in G1 (18.2 ± 11.4 min.) vs. G2 (28.5 ± 17.5 min.), p = 0.04. His capture thresholds were similar between groups (G1 = 1.56 ± 0.67 V vs G2 = 1.79 ± 0.85 V). Implant failure trended non-significantly lower in G1 (3/18, 17%) than G2 (7/20, 35%), p = 0.11. There were no acute procedural complications.
Conclusion: ICE guided HBLI was a feasible strategy that enabled rapid localization of the target HBLI site with less fluoroscopy, acceptable pacing threshold, and lack of procedural complications.