Impact of electroanatomical mapping-guided lead implantation on procedural outcome of His bundle pacing

Impact of electroanatomical mapping-guided lead implantation on procedural outcome of His bundle pacing

Abstract Aims Conventional His bundle pacing (HBP) can be technically challenging and fluoroscopy-intense, particularly in patients with His-Purkinje conduction disease (HPCD). Three-dimensional electroanatomical mapping (EAM) facilitates non-fluoroscopic lead navigation and HB electrogram mapping....

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Veröffentlicht in:Europace (London, England) England), 2021-03, Vol.23 (3), p.409-420
Hauptverfasser: Richter, Sergio, Ebert, Micaela, Bertagnolli, Livio, Gebauer, Roman, Lucas, Johannes, Scheller, Dominik, Paetsch, Ingo, Hindricks, Gerhard, Döring, Michael
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container_title Europace (London, England)
container_volume 23
creator Richter, Sergio
Ebert, Micaela
Bertagnolli, Livio
Gebauer, Roman
Lucas, Johannes
Scheller, Dominik
Paetsch, Ingo
Hindricks, Gerhard
Döring, Michael
description Abstract Aims Conventional His bundle pacing (HBP) can be technically challenging and fluoroscopy-intense, particularly in patients with His-Purkinje conduction disease (HPCD). Three-dimensional electroanatomical mapping (EAM) facilitates non-fluoroscopic lead navigation and HB electrogram mapping. We sought to assess the procedural outcome of routine EAM-guided HBP compared with conventional HBP in a real-world population and evaluate the feasibility and safety of EAM-guided HBP in patients with HPCD. Methods and results  We included 58 consecutive patients (72 ± 13 years; 71% male) who underwent an attempt to conventional (EAM− group; n = 29) or EAM-guided (EAM+ group; n = 29) HBP between June 2019 and April 2020. The centre’s learning curve was initially determined (n = 40 cases) to define the conventional control group and minimize outcome bias favouring EAM-guided HBP. His bundle pacing was successful in 26 patients (90%) in the EAM+ and 27 patients (93%) in the EAM− group (P = 0.64). The procedure time was 90 (73–135) and 110 (70–130) min, respectively (P = 0.89). The total fluoroscopy time [0.7 (0.5–1.4) vs. 3.3 (1.4–6.5) min; P 
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Three-dimensional electroanatomical mapping (EAM) facilitates non-fluoroscopic lead navigation and HB electrogram mapping. We sought to assess the procedural outcome of routine EAM-guided HBP compared with conventional HBP in a real-world population and evaluate the feasibility and safety of EAM-guided HBP in patients with HPCD. Methods and results  We included 58 consecutive patients (72 ± 13 years; 71% male) who underwent an attempt to conventional (EAM− group; n = 29) or EAM-guided (EAM+ group; n = 29) HBP between June 2019 and April 2020. The centre’s learning curve was initially determined (n = 40 cases) to define the conventional control group and minimize outcome bias favouring EAM-guided HBP. His bundle pacing was successful in 26 patients (90%) in the EAM+ and 27 patients (93%) in the EAM− group (P = 0.64). The procedure time was 90 (73–135) and 110 (70–130) min, respectively (P = 0.89). The total fluoroscopy time [0.7 (0.5–1.4) vs. 3.3 (1.4–6.5) min; P &lt; 0.001] and fluoroscopy dose [21.9 (9.1–47.7) vs. 78.6 (27.2–144.9) cGycm2; P = 0.001] were significantly lower in the EAM+ than EAM− group. There were no significant differences between groups in His capture threshold (1.2 ± 0.6 vs. 1.4 ± 1.0 V/1.0 ms; P = 0.33) and paced QRS duration (113 ± 15 vs. 113 ± 17 ms; P = 0.89). In patients with HPCD, paced QRS duration was similar in both groups (121 ± 15 vs. 123 ± 12 ms; P = 0.77). The bundle branch-block recruitment threshold tended to be lower in the EAM+ than EAM− group (1.3 ± 0.7 vs. 1.8 ± 1.2 V/1.0 ms; P = 0.31). No immediate procedure-related complications occurred. One patient (2%) experienced lead dislodgement during 4-week follow-up. Conclusion  Implementation of routine EAM-guided HBP lead implantation is feasible and safe in a real-world cohort of patients with and without HPCD and results in a tremendous reduction in radiation exposure without prolonging procedure time or increasing procedure-related complications.</description><identifier>ISSN: 1099-5129</identifier><identifier>EISSN: 1532-2092</identifier><identifier>DOI: 10.1093/europace/euaa292</identifier><identifier>PMID: 33253376</identifier><language>eng</language><publisher>England: Oxford University Press</publisher><ispartof>Europace (London, England), 2021-03, Vol.23 (3), p.409-420</ispartof><rights>Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2020. For permissions, please email: journals.permissions@oup.com. 2020</rights><rights>Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2020. For permissions, please email: journals.permissions@oup.com.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c335t-877dc8f26808ccb78ada0e78d97f83d7033e0cbe7b5fa4013ab707bbb29a04023</citedby><cites>FETCH-LOGICAL-c335t-877dc8f26808ccb78ada0e78d97f83d7033e0cbe7b5fa4013ab707bbb29a04023</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,1598,27901,27902</link.rule.ids><linktorsrc>$$Uhttps://dx.doi.org/10.1093/europace/euaa292$$EView_record_in_Oxford_University_Press$$FView_record_in_$$GOxford_University_Press</linktorsrc><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33253376$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Richter, Sergio</creatorcontrib><creatorcontrib>Ebert, Micaela</creatorcontrib><creatorcontrib>Bertagnolli, Livio</creatorcontrib><creatorcontrib>Gebauer, Roman</creatorcontrib><creatorcontrib>Lucas, Johannes</creatorcontrib><creatorcontrib>Scheller, Dominik</creatorcontrib><creatorcontrib>Paetsch, Ingo</creatorcontrib><creatorcontrib>Hindricks, Gerhard</creatorcontrib><creatorcontrib>Döring, Michael</creatorcontrib><title>Impact of electroanatomical mapping-guided lead implantation on procedural outcome of His bundle pacing</title><title>Europace (London, England)</title><addtitle>Europace</addtitle><description>Abstract Aims Conventional His bundle pacing (HBP) can be technically challenging and fluoroscopy-intense, particularly in patients with His-Purkinje conduction disease (HPCD). Three-dimensional electroanatomical mapping (EAM) facilitates non-fluoroscopic lead navigation and HB electrogram mapping. We sought to assess the procedural outcome of routine EAM-guided HBP compared with conventional HBP in a real-world population and evaluate the feasibility and safety of EAM-guided HBP in patients with HPCD. Methods and results  We included 58 consecutive patients (72 ± 13 years; 71% male) who underwent an attempt to conventional (EAM− group; n = 29) or EAM-guided (EAM+ group; n = 29) HBP between June 2019 and April 2020. The centre’s learning curve was initially determined (n = 40 cases) to define the conventional control group and minimize outcome bias favouring EAM-guided HBP. His bundle pacing was successful in 26 patients (90%) in the EAM+ and 27 patients (93%) in the EAM− group (P = 0.64). The procedure time was 90 (73–135) and 110 (70–130) min, respectively (P = 0.89). The total fluoroscopy time [0.7 (0.5–1.4) vs. 3.3 (1.4–6.5) min; P &lt; 0.001] and fluoroscopy dose [21.9 (9.1–47.7) vs. 78.6 (27.2–144.9) cGycm2; P = 0.001] were significantly lower in the EAM+ than EAM− group. There were no significant differences between groups in His capture threshold (1.2 ± 0.6 vs. 1.4 ± 1.0 V/1.0 ms; P = 0.33) and paced QRS duration (113 ± 15 vs. 113 ± 17 ms; P = 0.89). In patients with HPCD, paced QRS duration was similar in both groups (121 ± 15 vs. 123 ± 12 ms; P = 0.77). The bundle branch-block recruitment threshold tended to be lower in the EAM+ than EAM− group (1.3 ± 0.7 vs. 1.8 ± 1.2 V/1.0 ms; P = 0.31). No immediate procedure-related complications occurred. One patient (2%) experienced lead dislodgement during 4-week follow-up. 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Three-dimensional electroanatomical mapping (EAM) facilitates non-fluoroscopic lead navigation and HB electrogram mapping. We sought to assess the procedural outcome of routine EAM-guided HBP compared with conventional HBP in a real-world population and evaluate the feasibility and safety of EAM-guided HBP in patients with HPCD. Methods and results  We included 58 consecutive patients (72 ± 13 years; 71% male) who underwent an attempt to conventional (EAM− group; n = 29) or EAM-guided (EAM+ group; n = 29) HBP between June 2019 and April 2020. The centre’s learning curve was initially determined (n = 40 cases) to define the conventional control group and minimize outcome bias favouring EAM-guided HBP. His bundle pacing was successful in 26 patients (90%) in the EAM+ and 27 patients (93%) in the EAM− group (P = 0.64). The procedure time was 90 (73–135) and 110 (70–130) min, respectively (P = 0.89). The total fluoroscopy time [0.7 (0.5–1.4) vs. 3.3 (1.4–6.5) min; P &lt; 0.001] and fluoroscopy dose [21.9 (9.1–47.7) vs. 78.6 (27.2–144.9) cGycm2; P = 0.001] were significantly lower in the EAM+ than EAM− group. There were no significant differences between groups in His capture threshold (1.2 ± 0.6 vs. 1.4 ± 1.0 V/1.0 ms; P = 0.33) and paced QRS duration (113 ± 15 vs. 113 ± 17 ms; P = 0.89). In patients with HPCD, paced QRS duration was similar in both groups (121 ± 15 vs. 123 ± 12 ms; P = 0.77). The bundle branch-block recruitment threshold tended to be lower in the EAM+ than EAM− group (1.3 ± 0.7 vs. 1.8 ± 1.2 V/1.0 ms; P = 0.31). No immediate procedure-related complications occurred. One patient (2%) experienced lead dislodgement during 4-week follow-up. Conclusion  Implementation of routine EAM-guided HBP lead implantation is feasible and safe in a real-world cohort of patients with and without HPCD and results in a tremendous reduction in radiation exposure without prolonging procedure time or increasing procedure-related complications.</abstract><cop>England</cop><pub>Oxford University Press</pub><pmid>33253376</pmid><doi>10.1093/europace/euaa292</doi><tpages>12</tpages></addata></record>
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title Impact of electroanatomical mapping-guided lead implantation on procedural outcome of His bundle pacing
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