Key result
His bundle pacing achieves RBBB recruitment and narrows post-transplant QRS by ~48 msec.
Case Report (n=1)
No
His bundle pacing is a viable strategy to manage complete heart block post-heart transplant, offering physiologic pacing, right bundle branch recruitment, and preservation of the right ventricular septum for endomyocardial biopsy.
May support His bundle pacing for post-transplant conduction failure; leaves open efficacy and safety in larger prospective cohorts.
The incidence of permanent pacemaker implant after orthotopic heart transplant is between 2-24%. We present a 63-year-old male with ischemic cardiomyopathy who underwent orthotopic heart transplant. His post-operative course was complicated by recurrent asystole from sinus bradycardia and complete heart block. He had baseline right bundle branch block and right ventricular dysfunction. The decision was made to proceed with His-bundle pacing to provide physiologic cardiac activation, and provide anatomical benefit for subsequent endomyocardial biopsy. He did well after receiving a His bundle pacemaker with recruitment of his right bundle branch.
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Kristin Ellison (2021) conducted a case report in Complete heart block and right bundle branch block post-orthotopic heart transplant (n=1). His bundle pacing was evaluated on Right bundle branch recruitment and QRS narrowing. His bundle pacing successfully recruited the right bundle branch and narrowed the QRS duration from 152 msec to 104 msec in a post-heart transplant patient.
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