Permanent HIS bundle Pacing Feasibility in Routine Clinical Practice: Experience from an Indian Center

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Conduction disease requiring permanent pacing or indication for cardiac resynchronization therapy (CRT) (n=22). Intervention: Permanent His bundle pacing (HBP) using Select Secure 3830 lead and Select Site C315 sheath. Primary outcome: Procedural success (defined as a pacing threshold for His capture of ≤2.5 V at 1 ms).

Q: What does this research mean for the field?

Permanent His bundle pacing is feasible with an 86% implant success rate, maintaining stable capture thresholds and improving left ventricular ejection fraction in routine clinical practice. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.NEUTRAL.

Rakesh Sarkar; Daljeet Kaur; Muthiah Subramanian; Sachin Yalagudri; C. Sridevi; Soumen Devidutta; Debabrata Bera; Calambur Narasimhan

doi:10.1016/j.ihj.2019.09.003

July 1, 2019Indian Heart JournalOpen Access

Permanent HIS bundle Pacing Feasibility in Routine Clinical Practice: Experience from an Indian Center

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Key result

Permanent His bundle pacing achieves ~86% procedural success with stable thresholds at follow-up.

n=22

Figures

Why the study?

There is limited experience with His bundle pacing at centres initially adopting the procedure, particularly in the Indian setting.

Is permanent His bundle pacing feasible and safe for achieving physiological pacing in routine clinical practice among patients requiring permanent pacing or cardiac resynchronization therapy?

Key Points

To evaluate the procedural feasibility, safety, and clinical outcomes of permanent His bundle pacing in routine practice at a single center.
Single-center study evaluating permanent His bundle pacing attempted in 22 consecutive patients indicated for pacing therapy or in lieu of cardiac resynchronization therapy.
His bundle leads were positioned under fluoroscopic guidance to record injury currents and achieve selective or nonselective capture, followed for a mean of 15 ± 6.5 months.
Permanent His bundle pacing was successfully implanted in 19 of 22 patients (86%), achieving selective capture in 14 patients.
Left ventricular ejection fraction significantly improved from 36.7 ± 9.2% to 49.3 ± 9.3% in the subgroup with baseline dysfunction (n = 6).
Lead thresholds remained stable throughout follow-up in all except 1 patient, with zero lead dislodgements and no requirement for lead revisions.

Study Design

Type

Observational (n=22)

Multicenter

No

Structured PICO

Is permanent His bundle pacing feasible and safe for achieving physiological pacing in routine clinical practice among patients requiring permanent pacing or cardiac resynchronization therapy?

P

Population

22 adults (mean age 65.8 years, 50% female) requiring permanent pacing for conduction disease or cardiac resynchronization therapy at a single center in India, followed for a mean of 15 ± 6.5 months.

I

Intervention

Permanent His bundle pacing (HBP) under fluoroscopic guidance using a Medtronic Select Secure 3830 lead delivered via a Medtronic Select Site C315 sheath, with pacing assessed starting at 5 V at 1 ms pulse width (unipolar) before fixation.

O

Outcome

Procedural feasibility and success, defined as a pacing threshold for His capture of ≤2.5 V at 1 ms, and lead parameter stability over follow-up.surrogate

This first reported experience from India demonstrates that permanent His bundle pacing is a feasible and safe physiological pacing option with an 86% implant success rate, stable capture thresholds, and LVEF improvement in patients with LV dysfunction.

Limitations

Small sample size
Short follow-up
Single-center observational design
Patient selection for HBP was based on physician discretion due to lack of guidelines
Lack of guidelines at present meant HBP was attempted based on physician's discretion

Implication

Supports feasibility in this small series; hypothesis-generating and requires randomized confirmation before wider adoption.

Abstract

There is a paucity of experience regarding His bundle pacing (HBP) at laboratories initially attempting the procedure, especially in the Indian scenario. Patient who underwent HBP were selected for pacing therapy or in lieu of cardiac resynchronization therapy (CRT) at a single center. Among 22 patients attempted, 19 patients underwent successful implant, achieving selective HBP in 14 patients. There was a significant improvement in left ventricular ejection fraction (LVEF) (49.3 ± 9.3 vs. 36.7 ± 9.2) in the LV dysfunction subgroup (n = 6). Over a follow-up of 15 ± 6.5 months, thresholds were stable in all except one patient, and there was no requirement of lead revision. In summary, we found that HBP is a feasible option for achieving physiological pacing.

Discussion

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Cite This Study

Sarkar et al. (2019) conducted an observational in Conduction disease requiring permanent pacing or indication for cardiac resynchronization therapy (CRT) (n=22). Permanent His bundle pacing (HBP) using Select Secure 3830 lead and Select Site C315 sheath was evaluated on Procedural success (defined as a pacing threshold for His capture of ≤2.5 V at 1 ms).

synapsesocial.com/papers/6a7c91961b0fae09726ee123 https://doi.org/10.1016/j.ihj.2019.09.003

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Permanent HIS bundle Pacing Feasibility in Routine Clinical Practice: Experience from an Indian Center

Figures

Key Points

Study Design

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

Permanent HIS bundle Pacing Feasibility in Routine Clinical Practice: Experience from an Indian Center

Figures

Key Points

Study Design

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

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