Intermediate-term performance and safety of His-bundle pacing leads: A single-center experience

• Published in: Heart rhythm Vol. 18; no. 5; pp. 743 - 749
• Main Authors: Teigeler, Todd, Kolominsky, Jeffrey, Vo, Chau, Shepard, Richard K., Kalahasty, Gautham, Kron, Jordana, Huizar, Jose F., Kaszala, Karoly, Tan, Alex Y., Koneru, Jayanthi N., Ellenbogen, Kenneth A., Padala, Santosh K.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.05.2021
• Subjects: Aged; Atrioventricular Block - physiopathology; Atrioventricular Block - therapy; Bundle of His - physiopathology; Capture threshold; Cardiac Pacing, Artificial - methods; Cardiac resynchronization; Electrocardiography; Feasibility Studies; Female; Follow-Up Studies; Heart Rate - physiology; His-bundle pacing; Humans; Lead revision; Male; Physiological pacing; Retrospective Studies; Treatment Outcome; Ventricular Function, Left - physiology; Cardiac resynchronization; Capture threshold; Lead revision; Physiological pacing; His-bundle pacing
• ISSN: 1547-5271; 1556-3871
• DOI: 10.1016/j.hrthm.2020.12.031

The short-term safety, feasibility, and performance of His-bundle pacing (HBP) leads have been reported; however, their longer-term performance beyond 1 year remains unclear. The purpose of this study was to examine the intermediate-term performance and safety of HBP. All HBP lead implants at Virginia Commonwealth University between January 2014 and January 2019 were analyzed. HBP was performed using a Medtronic SelectSecure 3830-69 cm pacing lead. Of 295 attempts, successful HBP implantation (selective or nonselective) was seen in 274 cases (93%). Mean follow-up duration was 22.8 ± 19.5 months (median 19.5; interquartile range 11–33). 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%. Mean HBP capture threshold at implant was 1.1 ± 0.9 V at 0.8 ± 0.2 ms, which significantly increased at chronic follow-up to 1.7 ± 1.1 V at 0.8 ± 0.3 ms (P <.001). Threshold was ≥2.5 V in 24% of patients, and 28% had an increase in HBP threshold ≥1 V. Loss of His-bundle capture at follow-up (septal right ventricular pacing) was seen in 17%. There was a total of 31 (11%) lead revisions, primarily for unacceptably high thresholds. Although 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 of concern. Longer-term follow-up data from multiple centers are needed. [Display omitted]