Novel implant technique for septal pacing. A noninvasive approach to nonselective his bundle pacing

DANIEL, ORTEGA; ANALÍA, PAOLUCCI; BONOMINI, MARÍA PAULA; EMILIO, LOGARZO; NICOLÁS, MANGANI; LUIS, BARJA; MAZZETTI, EDUARDO

JOURNAL OF ELECTROCARDIOLOGY.

CHURCHILL LIVINGSTONE INC MEDICAL PUBLISHERS

Año: 2020 vol. 63 p. 35 - 40

0022-0736

Background. His Bundle pacing (HBP) preserves native ventricular activation through HisPurkinje. Unfortunately, most current techniques for HBP implants require sheaths, specialleads, and an electrophysiology setup for electrogram recording. Methods. We developed animplantation technique guided by a non-invasive assessment of left ventricular electricaldelay (LVED) as a measure of intraventricular dyssynchrony. The objective was to evaluatethe usefulness and safety of this technique for implants of pacemakers and ICDs with rightventricular septal pacing (RVSP) using conventional screw-in leads and compare it with areduced group of HBP (n=32) guided by His potential mapping. 208 patients eligible forventricular stimulation were implanted. Conventional screw-in leads were used in all cases.To ensure mechanical stability, stylets required a slight reshaping at the tip. Results. RVSPnormalized electrical activity in patients with conduction disease, producing NS-HBP-likepatterns. The parameters evaluated during implantation for the RVSP group were better thanthose of HBP and remained constant at a twelve months follow-up. In proportion, the numberof dislodgments and the need for CRT upgrade was lower for RVSP than for HBP.Additionally, fluoroscopy time was significantly reduced in the RVSP group. Conclusions.This technique successfully guided RVSP implants in a non-invasive way and represents asimple alternative to the implant of a cardiac stimulation device.