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A novel and practical technique to facilitate lead insertion at the His bundle region

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Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

Abstract

Background

His bundle (HB) pacing techniques are challenging and time-consuming. This is primarily due to the limitations in locating the relatively small area of the HB body for pacing.

Methods

Permanent HB pacing was performed in 133 consecutive patients with symptomatic bradycardia. A right atrial septo-gram (RAS) was performed in all patients to locate the HB. Briefly, 8–10 cc of contrast was injected through the Medtronic C315HIS delivery sheath while fluoroscopy cine runs were obtained in the RAO 15–20° projection. The images obtained provided the visualization of an approximately 90° angle composed by the medial aspect of the tricuspid valve annulus (TVA) anteriorly and the superior aspect of the interatrial septum superiorly. The apex of this angle coincides with the tip of the triangle of Koch (TK), where the HB body is usually located. A Medtronic SelectSecure™ MRI SureScan™ Model 3830 lead was then advanced and directed towards this area. The HB was mapped using pace mapping and unipolar recordings from the lead tip.

Results

Localization of the apex of the TK/HB body with the RAS was successful in all patients. The overall acute success of inserting the lead at the HB was 95%.

Conclusion

This study demonstrated that our method of utilizing a RAS to facilitate the localization the HB body proved to be safe and efficient in achieving permanent HB pacing with a success rate higher than previously reported.

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Authors and Affiliations

  1. Electrophysiology Division, UnityPoint Health Heart Center, Rock Island, IL, 61201, USA

    Helbert Acosta, Nathan Acosta, Gerardo Viafara, Alejandra de las Salas, Siri R. Pothula, Noah M. Acosta, Courtney Peckosh, Muddasir Ashraf, Jennifer Moore, Alimou Bah, Sergio Alzate, Michael W. LeMaster, Toni Martin & Luis Moron Mercado

  2. Orlando Veterans Affairs Medical Center, Orlando, FL, USA

    Gustavo Lopera

  3. University of Central Florida College of Medicine, Orlando, FL, USA

    Gustavo Lopera

Authors
  1. Helbert Acosta
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  2. Nathan Acosta
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  3. Gerardo Viafara
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  4. Alejandra de las Salas
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  5. Siri R. Pothula
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  6. Noah M. Acosta
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  10. Alimou Bah
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  13. Toni Martin
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  14. Luis Moron Mercado
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  15. Gustavo Lopera
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Corresponding author

Correspondence to Helbert Acosta.

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Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical approval

The study complied with the Declaration of Helsinki and was approved by the ethical committee of our institution.

Informed consent

All patients met criteria for permanent pacemaker therapy and signed written informed consent.

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Supplementary Information

ESM 1

Video of the right atrial septo-gram performed as an example case. (MOV 4.01 MB)

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Acosta, H., Acosta, N., Viafara, G. et al. A novel and practical technique to facilitate lead insertion at the His bundle region. J Interv Card Electrophysiol 66, 531–537 (2023). https://doi.org/10.1007/s10840-021-00941-z

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  • DOI: https://doi.org/10.1007/s10840-021-00941-z

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