DIRECT HIS-BUNDLE PERMANENT PACING AS AN ALTERNATIVE TO CONVENTIONAL RIGHT VENTRICULAR APICAL PACING: A PILOT STUDY IN ZAGAZIG UNIVERSITY CARDIAC ELECTROPHYSIOLOGY LABORATORY | ||||
| Zagazig University Medical Journal | ||||
| Article 13, Volume 20, Issue 2, March 2014, Page 1-7 PDF (489.81 K) | ||||
| Document Type: Original Article | ||||
| DOI: 10.21608/zumj.2014.4367 | ||||
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| Author | ||||
| Hisham S Roshdy Roshdy | ||||
| Cardiology department, Faculty of Medicine, Zagazig University, Zagazig, Egypt | ||||
| Abstract | ||||
| Aim: was to evaluate the feasibility of direct his bundle pacing (DHBP) as one of the physiological pacing approaches in our EP lab. Methods: All suitable patients admitted for permanent pacemaker implantation, between January and June 2013, were given a trial for DHBP. Using his bundle (HB) recording through a quadripolar catheter as an electrical and radiological guidance, custom shape stylet was used to direct an active fixation lead to the target position; a pacing protocol was applied to insure pure HB capture. A matching group of patients with apical right ventricular pacing (ARVP) were used as control, to assess the feasibility of DHBP technique. Results: Pure DHBP was successful in 12 out of 32 patients 38%.The DHBP procedure was costly when compared to ARVP in total procedure time (94.7±30.4 vs. 43.2±17.4 minutes), fluoroscopy time(35.2±10.9 vs. 10.1±3.6 minutes), patient x-ray exposure (34.1±7.8 vs. 11.9±4.9 Gy Cm2)and acute pacing threshold (2.1±0.6 vs.0.6±0.4 V). But in the other hand it was better in paced QRS width (76.8±14.8 vs. 193.9±35.8 ms.), patients’ exercise capacity as percentage of achieved METS from Max METS for age (75.5±8.7 vs.54.9±8.7%). the DHBP procedure time was progressively shorter indicating a steep learning curve. Conclusion: Although DHBP has many technical difficulties, it can be achieved with a reasonable coast in our EP lab with a demonstrable benefit, and a steep learning curve | ||||
| Keywords | ||||
| direct his bundle pacing; apical right ventricular pacing; physiological pacing; Pacemaker; paced QRS duration; and active fixation lead | ||||
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