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Vijayaraman P, Dandamudi G, Subzposh FA, Shepard RK, Kalahasty G, Padala SK, Strobel JS, Bauch TD, Ellenbogen KA, Bergemann T, Hughes L, Harris ML, Fagan DH, Yang Z, Koneru JN. Imaging-Based Localization of His Bundle Pacing Electrodes: Results From the Prospective IMAGE-HBP Study. JACC Clin Electrophysiol 2020; 7:73-84. [PMID: 33478715 DOI: 10.1016/j.jacep.2020.07.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 07/20/2020] [Accepted: 07/23/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES This study sought to evaluate the correlation between His bundle (HB) pacing (HBP) implantation characteristics, lead-tip location, and association of intraprocedural His recordings with approximated HB anatomic landmarks using computed tomography (CT) imaging. BACKGROUND HBP continues to grow in clinical practice due to offering true physiological pacing. However, a clear understanding of HB anatomy and the lead-tip location's influence on pacing characteristics is lacking. METHODS The IMAGE-HBP study (Imaging Study of Lead Implant for His Bundle Pacing) was a prospective, multicenter study designed to assess implantation characteristics of the SelectSecure Model 3830 lead placed at the HB, evaluate protocol-specified HBP success (His recording present on electrogram and HBP threshold ≤2.5 V at 1 ms), and correlation between lead-tip location by CT imaging and HBP characteristics as well as lead-related complications through 12 months. RESULTS Sixty-nine patients underwent a lead implantation attempt at the HB. Of these, 61 patients (88%) had a lead successfully implanted at the HB, and 52 patients (75%) met the pre-specified definition of successful HBP. In 51 patients with CT imaging, 11 leads (22%) were placed in the atrial aspect of the HB region (36% selective HBP), and 40 leads (78%) were placed in the ventricular aspect (28% selective HBP). Four of the 51 patients had P-wave oversensing, all with leads in the atrium. Freedom from lead-related complication at 12 months was 93%. CONCLUSIONS Successful HBP could be achieved at lead-tip locations in the atrium or ventricle but is preferable in the ventricle to eliminate risk of oversensing. The IMAGE-HBP study offers better insight into approximated HB anatomic landmarks, lead-tip location, and correlation with pacing characteristics. (Imaging Study of Lead Implant for His Bundle Pacing [IMAGE-HBP]; NCT03294317).
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Affiliation(s)
| | - Gopi Dandamudi
- Division of Cardiology, Division of Cardiac Electrophysiology, Indiana University, Indianapolis, Indiana, USA
| | | | - Richard K Shepard
- Department of Cardiology, Division of electrophysiology Virginia Commonwealth University, Richmond, Virginia, USA
| | - Gautham Kalahasty
- Department of Cardiology, Division of electrophysiology Virginia Commonwealth University, Richmond, Virginia, USA
| | - Santosh K Padala
- Department of Cardiology, Division of electrophysiology Virginia Commonwealth University, Richmond, Virginia, USA
| | - John S Strobel
- Division of Cardiology, Division of Cardiac Electrophysiology, Indiana University, Indianapolis, Indiana, USA
| | - Terry D Bauch
- Geisinger Heart Institute, Wilkes-Barre, Pennsylvania, USA
| | - Kenneth A Ellenbogen
- Department of Cardiology, Division of electrophysiology Virginia Commonwealth University, Richmond, Virginia, USA
| | | | - Lisa Hughes
- Medtronic, Inc., Mounds View, Minnesota, USA
| | | | | | | | - Jayanthi N Koneru
- Department of Cardiology, Division of electrophysiology Virginia Commonwealth University, Richmond, Virginia, USA
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Beer D, Sharma PS, Subzposh FA, Naperkowski A, Pietrasik GM, Durr B, Qureshi M, Panikkath R, Abdelrahman M, Williams BA, Hanifin JL, Zimberg R, Austin K, Macuch B, Trohman RG, Vanenkevort EA, Dandamudi G, Vijayaraman P. Clinical Outcomes of Selective Versus Nonselective His Bundle Pacing. JACC Clin Electrophysiol 2019; 5:766-774. [PMID: 31320004 DOI: 10.1016/j.jacep.2019.04.008] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 04/24/2019] [Accepted: 04/24/2019] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The aim of the study was to evaluate the clinical outcomes of nonselective (NS) His bundle pacing (HBP) compared with selective (S) HBP. BACKGROUND HBP is the most physiologic form of ventricular pacing. NS-HBP results in right ventricular septal pre-excitation due to fusion with myocardial capture in addition to His bundle capture resulting in widened QRS duration compared with S-HBP wherein there is exclusive His bundle capture and conduction. METHODS The Geisinger and Rush University HBP registries comprise 640 patients who underwent successful HBP. Our study population included 350 consecutive patients treated with HBP for bradyarrhythmic indications who demonstrated ≥20% ventricular pacing burden 3 months post-implantation. Patients were categorized into S-HBP or NS-HBP based on QRS morphology (NS-HBP n = 232; S-HBP n = 118) at the programmed output at the 3-month follow-up. The primary analysis outcome was a combined endpoint of all-cause mortality or heart failure hospitalization. RESULTS The NS-HBP group had a higher number of men (64% vs. 50%; p = 0.01), higher incidence of infranodal atrioventricular block (40% vs. 9%; p < 0.01), ischemic cardiomyopathy (24% vs. 14%; p = 0.03), and permanent atrial fibrillation (18% vs. 8%; p = 0.01). The primary endpoint occurred in 81 of 232 patients (35%) in the NS-HBP group compared with 23 of 118 patients (19%) in the S-HBP group (hazard ratio: 1.38; 95% confidence interval: 0.87 to 2.20; p = 0.17). Subgroup analyses of patients at greatest risk (higher pacing burden or lower left ventricular ejection fraction) revealed no incremental risk with NS-HBP. CONCLUSIONS NS-HBP was associated with similar outcomes of death or heart failure hospitalization when compared with S-HBP. Multicenter risk-matched clinical studies are needed to confirm these findings.
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Affiliation(s)
- Dominik Beer
- Division of Cardiology, Geisinger Heart Institute, Wilkes Barre, Pennsylvania
| | - Parikshit S Sharma
- Division of Cardiology, Rush University Medical Center, Chicago, Illinois
| | - Faiz A Subzposh
- Division of Cardiology, Geisinger Heart Institute, Wilkes Barre, Pennsylvania
| | - Angela Naperkowski
- Division of Cardiology, Geisinger Heart Institute, Wilkes Barre, Pennsylvania
| | | | - Brendan Durr
- Division of Cardiology, Geisinger Heart Institute, Wilkes Barre, Pennsylvania
| | - Maria Qureshi
- Division of Cardiology, Geisinger Heart Institute, Wilkes Barre, Pennsylvania
| | - Ragesh Panikkath
- Division of Cardiology, Geisinger Heart Institute, Wilkes Barre, Pennsylvania
| | - Mohamed Abdelrahman
- Division of Cardiology, Weil Cornell Medicine-New York Presbyterian Hospital, New York, New York
| | - Brent A Williams
- Division of Cardiology, Geisinger Heart Institute, Wilkes Barre, Pennsylvania
| | - Jillian L Hanifin
- Division of Cardiology, Rush University Medical Center, Chicago, Illinois
| | - Ryan Zimberg
- Division of Cardiology, Rush University Medical Center, Chicago, Illinois
| | - Kelly Austin
- Division of Cardiology, Geisinger Heart Institute, Wilkes Barre, Pennsylvania
| | - Brooke Macuch
- Division of Cardiology, Geisinger Heart Institute, Wilkes Barre, Pennsylvania
| | - Richard G Trohman
- Division of Cardiology, Rush University Medical Center, Chicago, Illinois
| | | | - Gopi Dandamudi
- Division of Cardiology, Indiana University, Indianapolis, Indiana
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