Document Detail

A feasible approach for direct his-bundle pacing using a new steerable catheter to facilitate precise lead placement.
MedLine Citation:
PMID:  16426396     Owner:  NLM     Status:  MEDLINE    
INTRODUCTION: Much clinical evidence has shown that right ventricular (RV) apical pacing is detrimental to left ventricular function. Preservation of the use of the His-Purkinje (H-P) system may be ideal in heart block that is restricted to the AV node, but may be of no benefit when H-P disease exists. AIM: To investigate the feasibility of direct His-bundle pacing (DHBP) using a new system consisting of a steerable catheter and a new 4.1 F screw-in lead. METHOD: Between May and December 2004, 26 patients (19 male, mean age: 77 +/- 5 years) with a standard pacemaker (PM) indication and preserved His-bundle conduction were enrolled and DHBP was attempted. RESULTS: DHBP was achieved in 24 patients (92%); two patients were paced in the His area, but the paced QRS morphology and duration were different from the native QRS. The mean time for lead positioning was 19 +/- 17 minutes, the mean fluoroscopy time was 11 +/- 8 minutes, and the total procedure time (skin-to-skin including positioning of a quadripolar diagnostic catheter for His recording) was 75 +/- 18 minutes. In DHBP pacing, the acute pacing threshold was 2.3 +/- 1.0 V at a pulse duration of 0.5 msec, and the sensed potentials were 2.9 +/- 2.0 mV. At a 3-month follow-up examination, the same QRS duration and morphology recorded on implantation were observed in all patients. The pacing threshold was 2.8 +/- 1.4 V, and sensed potentials were 2.5 +/- 1.8 mV; the sensing configuration was changed from bipolar to unipolar in 6 patients to resolve undersensing issues. No major complications were observed. CONCLUSIONS: This feasibility study shows that DHBP can be accomplished with a new system consisting of a steerable catheter and an active fixation lead in 92% of the patients in whom it was attempted.
Francesco Zanon; Enrico Baracca; Silvio Aggio; Gianni Pastore; Graziano Boaretto; Paola Cardano; Tiziana Marotta; Gianluca Rigatelli; Mariapaola Galasso; Mauro Carraro; Pietro Zonzin
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Publication Detail:
Type:  Comparative Study; Evaluation Studies; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of cardiovascular electrophysiology     Volume:  17     ISSN:  1045-3873     ISO Abbreviation:  J. Cardiovasc. Electrophysiol.     Publication Date:  2006 Jan 
Date Detail:
Created Date:  2006-01-23     Completed Date:  2006-05-04     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  9010756     Medline TA:  J Cardiovasc Electrophysiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  29-33     Citation Subset:  IM    
Division of Cardiology, Rovigo General Hospital, Rovigo, Italy.
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MeSH Terms
Bundle of His / physiopathology*
Cardiac Pacing, Artificial / methods*
Equipment Design
Feasibility Studies
Follow-Up Studies
Heart Block / physiopathology,  radiography,  therapy*
Pacemaker, Artificial*
Retrospective Studies
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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