Key result
Direct his bundle pacing was successful in 38% of patients and yielded narrower paced QRS width (76.8 vs 193.9 ms) and better exercise capacity (75.5% vs 54.9%) than apical right ventricular pacing.
Why the study?
Does direct His bundle pacing improve paced QRS width and exercise capacity compared to apical right ventricular pacing in patients requiring permanent pacemakers?
Cohort
No
Does direct His bundle pacing improve paced QRS width and exercise capacity compared to apical right ventricular pacing in patients requiring permanent pacemakers?
Direct His bundle pacing is feasible and provides better physiological pacing (narrower QRS and improved exercise capacity) than right ventricular apical pacing, though it requires longer procedure times and has a steep learning curve.
Answers are grounded in this paper and cite their sources.
May support His bundle pacing where feasible; leaves open confirmation in randomized trials.
Aim: was to evaluate the feasibility of direct his bundle pacing (DHBP) as one of the physiological pacing approaches in our EP lab.Methods: All suitable patients admitted for permanent pacemaker implantation, between January and June 2013, were given a trial for DHBP. Using his bundle (HB) recording through a quadripolar catheter as an electrical and radiological guidance, custom shape stylet was used to direct an active fixation lead to the target position; a pacing protocol was applied to insure pure HB capture. A matching group of patients with apical right ventricular pacing (ARVP) were used as control, to assess the feasibility of DHBP technique.Results: Pure DHBP was successful in 12 out of 32 patients 38%.The DHBP procedure was costly when compared to ARVP in total procedure time (94.7±30.4 vs. 43.2±17.4 minutes), fluoroscopy time(35.2±10.9 vs.10.1±3.6 minutes), patient x-ray exposure (34.1±7.8 vs. 11.9±4.9 Gy Cm2)and acute pacing threshold (2.1±0.6 vs.0.6±0.4 V). But in the other hand it was better in paced QRS width (76.8±14.8 vs. 193.9±35.8 ms.), patients’ exercise capacity as percentage of achieved METS from Max METS for age (75.5±8.7 vs.54.9±8.7%). the DHBP procedure time was progressively shorter indicating a steep learning curve.Conclusion: Although DHBP has many technical difficulties, it can be achieved with a reasonable coast in our EP lab with a demonstrable benefit, and a steep learning curve
No takes yet. Share an insight, caveat, or question.
Hisham Samir Roshdy (2014) conducted a cohort in Permanent pacemaker implantation. Direct his bundle pacing (DHBP) vs. Apical right ventricular pacing (ARVP) was evaluated on Feasibility of DHBP technique (success rate). Direct his bundle pacing was successful in 38% of patients and yielded narrower paced QRS width (76.8 vs 193.9 ms) and better exercise capacity (75.5% vs 54.9%) than apical right ventricular pacing.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: