Electrogram‐only guided approach to His bundle pacing with minimal fluoroscopy: A single‐center experience

• Published in: Journal of cardiovascular electrophysiology 2020-04, Vol.31 (4), p.805-812
• Main Authors: Zanon, Francesco, Marcantoni, Lina, Zuin, Marco, Pastore, Gianni, Baracca, Enrico, Tiribello, Antonella, Raffagnato, Paola, Boaretto, Graziano, Roncon, Loris, Vijayaraman, Pugazhendhi
• Format: Article
• Language: English
• Subjects: Action Potentials; Aged; Aged, 80 and over; Arrhythmias, Cardiac - diagnosis; Arrhythmias, Cardiac - physiopathology; Arrhythmias, Cardiac - therapy; Bundle of His - diagnostic imaging; Bundle of His - physiopathology; Cardiac Pacing, Artificial - adverse effects; electrical mapping; Electrophysiologic Techniques, Cardiac; Female; Fluoroscopy; Heart Rate; His bundle pacing; Humans; implant technique; Male; Middle Aged; Pacemaker, Artificial; physiological pacing; Predictive Value of Tests; Prospective Studies; Radiation Dosage; Radiation Exposure - prevention & control; Radiography, Interventional - adverse effects; Registries; Risk Factors; Time Factors; Treatment Outcome; zero fluoroscopy
• ISSN: 1045-3873; 1540-8167
• DOI: 10.1111/jce.14366

Introduction 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. Methods and Results 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. Conclusions 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.