Permanent His Bundle Pacing using Stylet Directed, Active Fixation Leads Placed via Coronary Sinus Sheaths as Compared to Conventional Lumen-less System.

Abstract

BACKGROUND\nThe use of coronary sinus sheaths to deliver stylet-driven leads for His bundle pacing (HBP) has not been described. Conventionally, HBP is achieved using a styletless lead delivered through a customized catheter.\n\n\nOBJECTIVES\nTo characterize the acute and early-term HBP experience with stylet-driven, active fixation leads delivered through coronary sinus sheaths as compared to conventional approach.\n\n\nMETHODS\nStylet-driven 4471 and 7742 leads (SDL) were attempted in 27 patients. Delivery was facilitated using CS guide catheters and custom-shaped stylets. Procedural characteristics and lead performance were compared to a group of 17 patients in whom 3830 lumen-less lead (LLL) was attempted. Patients had heterogeneous pacing indications.\n\n\nRESULTS\nHBP with SDL was successful in 24/27 (89%) patients compared to 15/17 (88%) in LLL group. Mean procedure and fluoroscopy times in SDL and LLL groups were 129±43 vs. 104±43 min, and 9.6±5.2 vs. 8.3±5.0 min, respectively (both p=ns). There was a significant difference in procedure and fluoroscopy times within SDL group between the first and second half of the series probably secondary to a learning curve. Acute HBP thresholds were higher with SDL: 2.6±1.5V vs. 1.5±1.2V with LLL (p=0.02) and remained stable at 8.4±5.3 months. Both stylet driven leads exhibited similar pacing thresholds. There were 2 crossovers between groups - 1 in each. Four patients with SDL and 1 patient with LLL exhibited high thresholds in follow-up.\n\n\nCONCLUSION\nPermanent HBP using stylet-driven, active-fixation leads delivered through conventional CS sheaths is feasible. Procedural characteristics and lead performance were clinically acceptable.