His bundle pacing in nodal versus infranodal atrioventricular block: a mid-term follow-up study
Introduction This study evaluated the feasibility of His bundle pacing (HBP) in consecutive, unselected patients with advanced atrioventricular block (AVB) over a medium-term follow-up period, comparing procedural characteristics between nodal and infranodal sites of the conduction block.Materials a...
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2023-08-01
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| Series: | Open Heart |
| Online Access: | https://openheart.bmj.com/content/10/2/e002542.full |
| _version_ | 1797211726667579392 |
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| author | Catalin Pestrea Ecaterina Cicala Alexandra Gherghina Florin Ortan Dana Pop |
| author_facet | Catalin Pestrea Ecaterina Cicala Alexandra Gherghina Florin Ortan Dana Pop |
| author_sort | Catalin Pestrea |
| collection | DOAJ |
| description | Introduction This study evaluated the feasibility of His bundle pacing (HBP) in consecutive, unselected patients with advanced atrioventricular block (AVB) over a medium-term follow-up period, comparing procedural characteristics between nodal and infranodal sites of the conduction block.Materials and methods Seventy-five consecutive patients with second-degree or third-degree AVB in which HBP was attempted were prospectively included in this study. The clinical and procedural-related characteristics of the patients were recorded at baseline and over a mid-term follow-up.Results 72% of the patients had normal QRS duration at baseline. Intracardiac electrograms revealed nodal AVB in 46 patients (61.3%). The permanent HBP procedural success was significantly higher in nodal AVB (84.8%) vs infranodal AVB (31%). There was no statistical difference between paced QRS duration, impedance, pacing and sensing thresholds and fluoroscopy time in the two groups. Infranodal block, baseline QRS duration, left bundle branch block morphology and ejection fraction were significantly associated with HBP procedural failure. The patients were followed for a period of 627.71±160.93 days. There were no significant differences in parameters at follow-up. An increase of >1 V in the His bundle (HB) capture threshold was encountered in one patient with infranodal AVB (11.1 %) and in four patients with nodal AVB (10.25%).Conclusion Permanent HBP is a feasible pacing technique in nodal AVB with a high success rate and stable thresholds in the medium term. Most infranodal blocks are located within the HB, so there is still the possibility to capture the conduction system, although with lower success rates. |
| first_indexed | 2024-03-08T18:13:30Z |
| format | Article |
| id | doaj.art-360d8792936649d1b47def4bd2d11f30 |
| institution | Directory Open Access Journal |
| issn | 2053-3624 |
| language | English |
| last_indexed | 2024-04-24T10:31:04Z |
| publishDate | 2023-08-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | Open Heart |
| spelling | doaj.art-360d8792936649d1b47def4bd2d11f302024-04-12T16:35:09ZengBMJ Publishing GroupOpen Heart2053-36242023-08-0110210.1136/openhrt-2023-002542His bundle pacing in nodal versus infranodal atrioventricular block: a mid-term follow-up studyCatalin Pestrea0Ecaterina Cicala1Alexandra Gherghina2Florin Ortan3Dana Pop4Department of Interventional Cardiology, Brasov County Emergency Hospital, Brasov, RomaniaDepartment of Interventional Cardiology, Brasov County Emergency Hospital, Brasov, RomaniaDepartment of Interventional Cardiology, Brasov County Emergency Hospital, Brasov, RomaniaDepartment of Interventional Cardiology, Brasov County Emergency Hospital, Brasov, Romania5th Department of Internal Medicine, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca, RomaniaIntroduction This study evaluated the feasibility of His bundle pacing (HBP) in consecutive, unselected patients with advanced atrioventricular block (AVB) over a medium-term follow-up period, comparing procedural characteristics between nodal and infranodal sites of the conduction block.Materials and methods Seventy-five consecutive patients with second-degree or third-degree AVB in which HBP was attempted were prospectively included in this study. The clinical and procedural-related characteristics of the patients were recorded at baseline and over a mid-term follow-up.Results 72% of the patients had normal QRS duration at baseline. Intracardiac electrograms revealed nodal AVB in 46 patients (61.3%). The permanent HBP procedural success was significantly higher in nodal AVB (84.8%) vs infranodal AVB (31%). There was no statistical difference between paced QRS duration, impedance, pacing and sensing thresholds and fluoroscopy time in the two groups. Infranodal block, baseline QRS duration, left bundle branch block morphology and ejection fraction were significantly associated with HBP procedural failure. The patients were followed for a period of 627.71±160.93 days. There were no significant differences in parameters at follow-up. An increase of >1 V in the His bundle (HB) capture threshold was encountered in one patient with infranodal AVB (11.1 %) and in four patients with nodal AVB (10.25%).Conclusion Permanent HBP is a feasible pacing technique in nodal AVB with a high success rate and stable thresholds in the medium term. Most infranodal blocks are located within the HB, so there is still the possibility to capture the conduction system, although with lower success rates.https://openheart.bmj.com/content/10/2/e002542.full |
| spellingShingle | Catalin Pestrea Ecaterina Cicala Alexandra Gherghina Florin Ortan Dana Pop His bundle pacing in nodal versus infranodal atrioventricular block: a mid-term follow-up study Open Heart |
| title | His bundle pacing in nodal versus infranodal atrioventricular block: a mid-term follow-up study |
| title_full | His bundle pacing in nodal versus infranodal atrioventricular block: a mid-term follow-up study |
| title_fullStr | His bundle pacing in nodal versus infranodal atrioventricular block: a mid-term follow-up study |
| title_full_unstemmed | His bundle pacing in nodal versus infranodal atrioventricular block: a mid-term follow-up study |
| title_short | His bundle pacing in nodal versus infranodal atrioventricular block: a mid-term follow-up study |
| title_sort | his bundle pacing in nodal versus infranodal atrioventricular block a mid term follow up study |
| url | https://openheart.bmj.com/content/10/2/e002542.full |
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