Modified techniques for permanent His-bundle pacing, including a dual-lead method and stability assessment, increased the acute success rate from 84.85% to 99.20% (P<0.001).
Observational (n=310)
No
Does the addition of a dual-lead method and stability assessment improve the success rate and pacing parameters of permanent His-bundle pacing in patients with narrow QRS?
The use of a dual-lead method and stability assessment techniques significantly improves the implantation success rate and pacing thresholds of permanent His-bundle pacing in patients with narrow QRS.
Absolute Event Rate: 99.2% vs 84.85%
p-value: p=<0.001
AIMS: High and unstable capture thresholds affect the success rate of permanent His-bundle pacing (HBP). We aimed to introduce the modified techniques during different periods and the corresponding success rate of HBP implantation. METHODS AND RESULTS: Patients from a single centre who had intrinsic QRS < 120 ms and HBP attempts were included in the study. The success rate and pacing parameters were described for three periods based on procedural modifications, i.e. Stage 1 using the conventional HBP procedure (August 2012 to May 2013), Stage 2 with addition of the dual-lead method (June 2013 to October 2014), and Stage 3 with the further addition of stability assessment during fixation (November 2014 to October 2016). The patients with successful permanent HBP were followed. A total of 310 patients were included with the average age of 70.3 ± 10.7 years. The success rate of acute HBP was 84.85%, 98.3%, and 99.20% during Stages 1-3, respectively (P < 0.001). The permanent HBP implantation rates increased from 77.3% during Stage 1 to 85.7% during Stage 2 and 89.6% during Stage 3 (P = 0.07). The acute His-bundle capture threshold reduced from 1.30 ± 0.7 V/0.5 ms during Stage 1 to 1.11 ± 0.6 V/0.5 ms during Stage 2 and further to 0.85 ± 0.51 V/0.5 ms during Stage 3 (P < 0.001). At the 12-month follow-up, the mean change in the HBP threshold decreased from 0.60 ± 0.59 V/0.5 ms during Stage 1 to 0.33 ± 0.39 V/0.5 ms during Stage 3 (P = 0.002). CONCLUSION: The HBP implantation success rate, pacing threshold, and its stability during follow-up were improved by using the dual-lead method and stability assessment techniques.
Su et al. (Tue,) conducted a observational in Patients with narrow QRS requiring pacing (n=310). Modified techniques for permanent His-bundle pacing (dual-lead method and stability assessment) vs. Conventional HBP procedure was evaluated on Success rate of acute HBP (p=<0.001). Modified techniques for permanent His-bundle pacing, including a dual-lead method and stability assessment, increased the acute success rate from 84.85% to 99.20% (P<0.001).