The Efficacy of His Bundle Pacing: Lessons Learned From Implementation for the First Time at an Experienced Electrophysiology Center
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Author + information
- Advay G. Bhatt, MD∗ (bhatad{at}valleyhealth.com),
- Dan L. Musat, MD,
- Nicolle Milstein, MS,
- Jacqueline Pimienta, BA,
- Laura Flynn, NP,
- Tina Sichrovsky, MD,
- Mark W. Preminger, MD and
- Suneet Mittal, MD
- Valley Health System and the Snyder Center for Comprehensive Atrial Fibrillation, Ridgewood, New Jersey
- ↵∗Address for correspondence:
Dr. Advay G. Bhatt, Valley Health System, 970 Linwood Avenue, Paramus, New Jersey 07652.
Graphical abstract
Abstract
Objectives This study sought to evaluate the clinical and procedural characteristics impacting outcomes during implementation of a His bundle pacing (HBP) program in a real-world setting.
Background Right ventricular pacing is associated with an elevated risk of heart failure, but device reprogramming and upgrades have significant challenges. HBP has emerged as an alternative and is reported to be highly successful in the hands of highly experienced centers.
Methods All patients referred for permanent pacemaker implantation at the Valley Hospital (Ridgewood, New Jersey) between October 2015 and October 2017 were evaluated; a subset of 24% was selected for HBP.
Results Permanent HBP was feasible with an acute implant success rate of 75%. HBP in the presence of bundle branch block (64% vs. 85%; p = 0.05) or complete heart block (56% vs. 83%; p = 0.03) was significantly less successful. The pattern of atrioventricular block in combination with bundle branch block (BBB) further affects outcomes. HBP is highly successful across the spectrum of atrioventricular block pattern severity in the absence of BBB. In the presence of BBB, Mobitz II AV block and complete heart block significantly attenuated HBP success compared with Mobitz I atrioventricular block (62% vs. 100%; p = 0.02). A rising threshold was observed in 30%, and 8% required lead intervention.
Conclusions HBP was feasible and readily learned with a high implant success in the hands of experienced electrophysiologists without prior exposure to the technique. BBB and atrioventricular block pattern appears to affect success. The technique is limited by a high rate of rising thresholds and lead intervention. These data have important implications for patient selection.
Footnotes
Dr. Mittal is a consultant to Abbott, Boston Scientific, and Medtronic. Dr. Bhatt is a consultant to Abbott and Medtronic. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
All authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- Received May 29, 2018.
- Revision received July 10, 2018.
- Accepted July 26, 2018.
- 2018 American College of Cardiology Foundation
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