Heart rhythm | 2021
Intermediate Term Performance and Safety of His Bundle Pacing Leads: A Single Center Experience.
Abstract
BACKGROUND\nThe short-term safety, feasibility, and performance of the His bundle pacing (HBP) leads have been reported, however, their longer-term performance beyond 1 year remains unclear.\n\n\nOBJECTIVE\nThe objective of this study was to examine the intermediate-term performance and safety of HBP.\n\n\nMETHODS\nAll HBP lead implants at Virginia Commonwealth University between 01-2014 and 01-2019 were analyzed. HBP was performed using a SelectSecureTM 3830-69 cm pacing lead (Medtronic, Minneapolis, MN).\n\n\nRESULTS\nOf 295 attempts, successful HBP implantation (selective or non-selective) was seen in 274 (93%) cases. The mean follow-up duration was 22.8±19.5 months (median 19.5 months, IQR 11-33 months). Mean age was 69±15 years, 58% were males, and ejection fraction <50% was noted in 30%. Indications for pacemaker included sick sinus syndrome in 41%, atrioventricular block in 36%, cardiac resynchronization therapy in 7%, and refractory atrial fibrillation in 15%. Selective HBP was achieved in 33%. The mean HBP capture threshold at implant was 1.1±0.9V at 0.8±0.2ms which significantly increased at chronic follow-up to 1.7±1.1V at 0.8±0.3ms (P<0.001). Threshold was ≥2.5V in 24% patients, and 28% had an increase in HBP threshold ≥1V. Loss of His bundle capture at follow-up (septal RV pacing) was seen in 17%. There was a total of 31 (11%) lead revisions, primarily for unacceptably high thresholds.\n\n\nCONCLUSION\nWhile HBP can prevent or improve pacing induced cardiomyopathy, the elevated capture thresholds, loss of His bundle capture, and lead revision rates at intermediate follow-up are concerning. Longer-term follow-up data from multiple centers are needed.