Electrogram-only guided approach to His bundle pacing with minimal fluoroscopy: A single-center experience.
Action Potentials
Aged
Aged, 80 and over
Arrhythmias, Cardiac
/ diagnosis
Bundle of His
/ diagnostic imaging
Cardiac Pacing, Artificial
/ adverse effects
Electrophysiologic Techniques, Cardiac
Female
Fluoroscopy
Heart Rate
Humans
Male
Middle Aged
Pacemaker, Artificial
Predictive Value of Tests
Prospective Studies
Radiation Dosage
Radiation Exposure
/ prevention & control
Radiography, Interventional
/ adverse effects
Registries
Risk Factors
Time Factors
Treatment Outcome
His bundle pacing
electrical mapping
implant technique
physiological pacing
zero fluoroscopy
Journal
Journal of cardiovascular electrophysiology
ISSN: 1540-8167
Titre abrégé: J Cardiovasc Electrophysiol
Pays: United States
ID NLM: 9010756
Informations de publication
Date de publication:
04 2020
04 2020
Historique:
received:
25
11
2019
revised:
31
12
2019
accepted:
15
01
2020
pubmed:
25
1
2020
medline:
3
2
2021
entrez:
25
1
2020
Statut:
ppublish
Résumé
His bundle pacing (HBP) is the most physiological pacing. The standard technique based on fluoroscopic approach might be challenging and fluoro consuming. Targeting the His guided exclusively by the electrical signals could enable a precise lead implant, thus reducing fluoroscopy time (FT) and X-ray dose, desirable both for patients and operators. The aim of the study is to evaluate the feasibility, efficacy, and safety both acutely and at 30 days of the electrogram (EGM)-guided HBP with minimal or no fluoroscopy. Between October and December 2018, 41 consecutive patients underwent EGM-guided HBP. Successful HBP was obtained in 39 (95%) patients, (30 males, 78 ± 10 years). Selective HBP (S-HBP) was achieved in 23 (59%), nonselective HBP (NS-HBP) in 16 (41%) patients. The final HBP lead position was reached in 31 (79.4%) patients without fluoroscopy, only guided by electrical signals. In eight patients a minimal fluoroscopy (mean, 8 seconds) has been required. The sheath's cutting and the slack of the lead were routinely performed under fluoroscopy. No difference was observed in FT for HBP lead placement in S-HBP and NS-HBP (mean, 8.1 ± 25 vs 7.5 ± 20 seconds, P = .8; median value 0 vs 0 seconds). No differences were observed in FT for the entire procedure, total dose area product and total procedural time in S-HBP and NS-HBP. Lead dislodgement occurred in one (2.6%) patient 1 day after the procedure. HBP could be performed safely and efficiently using the EGMs, with minimal or no fluoroscopy. Fluoroscopy was required during sheath removal and atrial lead placement.
Types de publication
Journal Article
Observational Study
Video-Audio Media
Langues
eng
Sous-ensembles de citation
IM
Pagination
805-812Commentaires et corrections
Type : CommentIn
Type : CommentIn
Informations de copyright
© 2020 Wiley Periodicals, Inc.
Références
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