HIS Bundle Pacing

Has anyone in the group had a procedure done called HIS Bundle Pacing? It is an alternative to putting the third wire into the coronary sinus vein if you have a CRT implant and are having difficulty in placing the third wire properly ,

My EP suggested it but said it is a new procedure and only a handful of EPs have the experience to do this.

 

3 Comments

His bundle pacing

by AgentX86 - 2018-10-03 15:56:25

His pacing is an alternative but I'm not sure there are any benefits to it. Of course,  It isn't a possibility if there is any LBB or RBB blocks, or any other blocks higher up that could get progressively worse.

If your EP is proposing His pacing, I assume he thinks it's the best option for your case.

 

His-bundle pacing--not that new and better known all the time

by Gotrhythm - 2018-10-03 16:37:48

Pacing through the His-bundle located in the center of the heart is thought to be more physiologically "normal" and some studies have shown His-bundle pacing to have fewer long term negative consequences. HIs-bundle pacing is being done in more and more centers. However, it does have to be put in exactly the right place, and so implanting it takes more skill than the more common two and three lead pacemakers. 

His-bundle pacing was developed at Geisinger Heart Institute in Wilkes Barre Pennsylvania, where they have done hundreds. Because in some cases there are real benefits more heart centers are now offering it.

You might need to travel, but it shouldn't be hard to find a heart center where there is knowledge and depth of experience in the procedure. 

His Bundle pacing

by fox30 - 2018-12-21 16:01:26

I had a bundle his pacing system implanted in October 2015 and it has worked great every since.

It actually can be used successfully in cases of left bundle branch block ( I have/had one)  In many cases BOH pacing can "correct LBBB" as it did in my case.I had intermitent second degree heart induced by exercise AND a LBBB. My EP put the lead in the his bundle location plus a lead in the coronary sinus as is done in CRT, that lead being a back up. A back up was done as in 2015 HBP was fairly new ( in the US at least while it had been more widely used in Europe). An article from Europe demonstrated the HBP was feasible as early as 2010. 

The EP docs from Geisinger gave a poster presentation of their early experience at an EP meeting in 2015 and later a paper and since then there has been a large number of papers regarding HBP in the medical literature and it is being done in many locations in the US.

An article in Medscape in March 2018 ( an online publication) by a Dr. Francesco Zanon from Italy reported that his group uses HBP for all patients referred for PM implantation. 

All US docs may not be that enthusiastic  but more and more EP docs are doing the procedure. Negatives inlclude 1) possible high threshold for capture of the HB lead versus the standard lead in the apex of the right ventricle (mine has been stable for 3 years at 1.5 V @0.40 ms)

2)HBP cannot be acheived in all patients ( centers with experience quote succes rates from 75 % to 90 + %  

3) because of 1) battery replacement may be needed sooner .

If your EP is suggesting HBP you might ask him how many has he done as there is a bit of a learning curve involved.

 

 

 

 

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