Novel Wide-Band Dielectric Imaging System Guided Lead Deployment for His Bundle Pacing: A Feasibility Study

Figures

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  Figure 1. His Bundle Pacing implantation in the standard group. (A) Sinus rhythm before the procedure. (B) His potential was recorded during the procedure. (C) Selective His bundle pacing was confirmed at a lower pacing output. (D) Nonselective His bundle pacing was achieved at a higher pacing output. (E) Final lead location in the fluoroscopic image.

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  Figure 2. Flowchart of the procedure details in the EAM-guided group. EAM, electroanatomical mapping; HB, His bundle.

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  Figure 3. Locating the HB region in the EAM-guided group. Based on the electrical field information, the three-dimensional (3D) cardiac anatomical image was calculated and visualized by moving the catheter without fluoroscopy. The TVA was highlighted (yellow dots in the figure), and the HB region (purple dots in the figure) where the HB potential could be recorded was marked under the guidance of the TVA location. EGMs from top to bottom showed the cardiac signal recorded from the external dielectric sensors, quadripolar catheter 1–2, and quadripolar catheter 3–4, respectively. EAM, electroanatomical mapping; EGM, electrogram; HB, His bundle; RBB, right bundle branch; TVA, tricuspid valve annulus.

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  Figure 4. Anatomical image calculated by the KODEX-EPD system. (A) Anatomical image in RAO view. (B) Enlarged image in RAO view. (C) Image in LAO view. (D) Enlarged image in LAO view. The purple and orange dots represent the sites where the His bundle potential can be recorded. The yellow dots represent the path of the tricuspid valve annulus. LAO, left anterior oblique; RAO, right anterior oblique; RBB, right bundle branch.

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  Figure 5. HB lead deployment in the EAM-guided group. After the HB region was successfully marked, the lead was navigated to the HB region under the guidance of the KODEX-EPD system without fluoroscopy. The glass view provided by this system (setting of “opacity”) could give an enhanced perception of the lead location and orientation within the heart. The lead was finally fixed in the target HB region. The yellow dots represent the path of the tricuspid valve annulus. The purple dots represent the sites where the HB potential can be recorded. The orange dots represent the target HB region. EGMs from top to bottom showed the cardiac signal recorded from the external dielectric sensors and the 3830 pacing lead, respectively. EAM, electroanatomical mapping; EGM, electrogram; HB, His bundle; RBB, right bundle branch.

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  Figure 6. PANO view of the KODEX-EPD system. The anatomical image in the KODEX system can be displayed as a novel panoramic (PANO) view, which transforms the 3D cardiac structure into a virtual two-dimensional (2D) panoramic picture. This view allows all the anatomically relevant structures to be seen in one view. The percentage of open (0% open to 100% open) represents the degree of transformation from a 3D image to a flattened image, 0% open means the image is still shown as a 3D cardiac structure, while 100% open means the full unfolding of the 3D cardiac structure. CS, coronary sinus; RAA, right atrial appendage; SVC, superior vena cava; TVA, tricuspid valve annulus.