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116/Safety and feasibility of His bundle pacing at a tertiary cardiac centre

European Journal of Arrhythmia & Electrophysiology. 2019;5(Suppl. 1):abstr116

Introduction: Permanent His Bundle pacing has been reported as a promising alternative to conventional right ventricular and biventricular pacing due to its ability to deliver and potentially correct intrinsic His-Purkinje conduction. We performed a medium term follow up study of patients who underwent His Bundle Pacing (HBP) to examine safety, feasibility and stability of lead parameters.
Methods: HBP was performed using a Medtronic 3830 SelectSecure lead through either a Medtronic C304 deflectable guide catheter or a C315 fixed curve guide catheter. A total of 15 patients underwent HBP, including 11 (73%) males with a mean age of 71.2 ± 9 years. Thirteen patients had documented left ventricular dysfunction. ECG abnormalities included left bundle branch block (n=4), right bundle branch block (n=3), 1st degree AV block (n=2), Mobitz type 2 second degree AV block (n=2),
complete heart block (n=3) or atrial fibrillation prior to AV node ablation (n=1). All patients had a RV pacing/defibrillator lead. Patients were followed up for a mean duration of 29.1 ± 9.1 weeks.
Results: Mean fluoroscopy time was 20.2 ± 16.4 minutes and mean radiation dose was 8 mG. Selective His capture was achieved in 6 (40%) of patients. There was no statistically significant difference between the mean threshold at implant and follow up, 1.4 ± 1.69 volts at 1 ms versus 1.27 ± 1 volts at 1 ms respectively (p=0.69) (see Figure 1). Sensing was 5.3 ± 5.4 millivolts at implant with no statistically significant difference at follow-up (p=0.4). Lead impedance was also similar at implant and follow-up, 593 ± 179 Ohms versus 423 ± 68 Ohms respectively, p=0.18. There were no reported complications during all procedures and at follow up.
Conclusion: In our case series His Bundle Pacing was found to be safe, feasible and associated with stable lead parameters during follow-up. There are several potential roles for HBP in clinical practice. Randomised control studies are necessary to define these roles and assess long term clinical efficacy.

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