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Implantation technique of His bundle pacing

Implantationstechnik für die His-Bündel-Stimulation

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Abstract

His bundle pacing (HBP) preserves physiological ventricular synchrony, with clinical benefits particularly evident when a high percentage of ventricular pacing is required. First experiences with standard leads and manually shaped stylets produced the impression that HBP is highly complex and time-consuming. However, with dedicated leads and sheaths, reliable HBP can be achieved in routine clinical practice. Implantation success in more than 90% of patients can be reached with current technology and has been shown to be reliable and effective, both at implantation and during long-term follow-up. At the same time, fluoroscopy and total procedural time can be reduced. New customized technologies will continue to improve the implant success rate and system performance. Large randomized trials will prove the long-term clinical benefits of HBP definitively and may render HBP the first choice in patients requiring ventricular pacing.

Zusammenfassung

Die His-Bündel-Stimulation (HBS) bewahrt die physiologische Synchronität mit ihren klinischen Vorteilen, insbesondere bei Patienten, die einen hohen Anteil ventrikulärer Stimulation benötigen. Erste Erfahrungen mit Standardelektroden und manuell vorgebogenen Mandrins vermittelten den Eindruck, dass die HBS hochkomplex und zeitaufwendig wäre. Mit speziellen Elektroden und Schleusen kann jedoch eine zuverlässige His-Bündel-Stimulation auch in der klinischen Routine erreicht werden. Die derzeitige Technologie ermöglicht eine erfolgreiche Implantation bei mehr als 90 % der Patienten und hat sich als zuverlässig und effektiv erwiesen, sowohl bei der Implantation als auch im Langzeit-Follow-up. Gleichzeitig können die Fluoroskopie- und Prozedurgesamtdauer reduziert werden. Neue angepasste Technologien werden die Implantationserfolgsrate weiter steigern und die Systemfunktion optimieren. Große randomisierte Studien werden den klinischen Langzeitnutzen der HBS wohl definitiv nachweisen und könnten die HBS bei Patienten, die eine ventrikuläre Stimulation benötigen, zur Therapie der ersten Wahl machen.

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Authors and Affiliations

  1. Arrhythmia and Electrophysiology Unit, Dept of Cardiology, Santa Maria della Misericordia General Hospital, Rovigo, Italy

    Lina Marcantoni MD, Marco Zuin MD, Enrico Baracca MD, Gianni Pastore MD, Paola Raffagnato RN, Antonella Tiribello RN, Graziano Boaretto RN & Francesco Zanon MD, FESC, FHERA, FHRS

Authors
  1. Lina Marcantoni MD
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  2. Marco Zuin MD
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  3. Enrico Baracca MD
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  4. Gianni Pastore MD
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  5. Paola Raffagnato RN
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  6. Antonella Tiribello RN
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  7. Graziano Boaretto RN
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  8. Francesco Zanon MD, FESC, FHERA, FHRS
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Corresponding author

Correspondence to Francesco Zanon MD, FESC, FHERA, FHRS.

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Conflict of interest

L. Marcantoni received modest speaker fee (modest) from Abbott. F. Zanon received modest speaker fee (modest) from Abbott, Biotronik, Boston Scientific, Medtronic, Microport. M. Zuin, E. Baracca, G. Pastore, P. Raffagnato, A. Tiribello and G. Boaretto declare that they have no competing interests.

For this article no studies with human participants or animals were performed by any of the authors. All studies performed were in accordance with the ethical standards indicated in each case.

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Marcantoni, L., Zuin, M., Baracca, E. et al. Implantation technique of His bundle pacing. Herzschr Elektrophys 31, 111–116 (2020). https://doi.org/10.1007/s00399-020-00681-z

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