Allied Professionals (Non-physician submissions only) -> Clinical Research D-PO01 - Featured Poster Session (ID 11) Poster

D-PO01-045 - His Bundle Pacemaker Patients Require A More Comprehensive Follow Up Routine (ID 895)

 T.F. Wazny-Kohl: Nothing relevant to disclose.


Background: Since HIS Bundle Pacing (HBP) was first identified in the early 2000s, many implanters have embraced this device option for treatment of underlying conduction disturbances.
Objective: To determine if current standards of device checks used in our clinic are suitable for determining HBP outcomes and optimal programming.
Methods: Current protocol in the Device Clinic includes single-lead ECG programmer method (SLM). Patients were tested using SLM, then with a 12-lead ECG (12LM). In patients with underlying conduction delay (UCD) pulse width (PW) duration, PW polarity, AV delays (AVD) starting from 50ms to 200ms were tested each delay documented on 12LM, taking note of conduction changes and axis changes. Voltages at which HIS block is resolved and at which total loss of capture is noted; starting at 2v and decrementing down to total loss of capture; each voltage documented on 12LM taking note of conduction changes and axis changes. 12LM recordings include presenting rhythm, underlying rhythm, HIS block resolution and total loss of HIS capture.
Results: Of 550 HBP patients followed in the Device Clinic, there was no significant difference found in SL ECG vs 12LM testing of patients with normal QRS. However, the 12L ECG had significant advantage in addressing UCD. Compared to programming deemed satisfactory with SL ECG, changes were made after testing using 12L ECG 85 of 110 pts showing UCD. Programming changes included PW duration and/or polarity, increasing pacing voltage or changing AV delays to address UCD. Typically, SL ECG, determined capture voltage but not effect on UCD.
Conclusion: Compared to SL ECG, using a 12LM ECG uncovered required changes in pacing pulse, voltage as well as AV delays to correct underlying conduction disturbance. 12LM ECG identifies UCD that is not easily detected by SL ECG A more comprehensive programming approach should be utilized for all HBP patients especially those with UCD.