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His bundle pacing: troubleshooting at implantation

His-Bündel-Stimulation – Troubleshooting bei der Elektrodenimplantation

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Abstract

His bundle pacing produces electrocardiograms (ECGs) that give the impression that it is physiological like no other form of cardiac pacing requiring ventricular stimulation. Several special features of the implantation technique of a His bundle lead that distinguish it significantly from the implantation of other endocardial leads need to be considered. This overview provides a number of practical “hands-on” tips and tricks, from implantation set-up (12-lead ECG, no electrophysiology unit, no His bundle catheter), venous access, handling of delivery catheters and leads, interpretation of intracardiac electrograms, fluoroscopy and the surface ECG, finding the optimal pacing site, and implantation of the lead to fine-tuning and troubleshooting of difficult implantations and lead dislodgement. This review should help to facilitate the implantation of His bundle leads, shorten the learning curve and help to improve implantation results.

Zusammenfassung

Die His-Bündel-Stimulation erzeugt Elektrokardiogramme (EKG), die diese Stimulationsform als physiologisch wie keine andere Form ventrikulärer Stimulation erscheinen lassen. Bei der Implantation einer His-Bündel-Elektrode sind einige Besonderheiten zu beachten, die sie deutlich von der Implantation anderer endokardialer Elektroden unterscheiden. In dieser Übersicht werden praktische Tipps gegeben, die folgende Bereiche abdecken: Set-up (12-Kanal-EKG, keine Elektrophysiologieeinheit und kein His-Bündel-Katheter); venöser Zugang, Handhabung der Schleusen und Elektroden; Interpretation des intrakardialen Elektrogramms, der Fluoroskopie und des Oberflächen-EKGs; Suche des optimalen Stimulationsorts; Elektrodenimplantation; Feinabstimmung; Troubleshooting bei schwierigen Implantationen und Elektrodendislokationen. Die Tipps sollen die Implantation von Elektroden für die His-Bündel-Stimulation erleichtern, die Lernkurve verkürzen und zur Optimierung des Implantationsergebnisses beitragen.

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Authors and Affiliations

  1. Klinik für Innere Medizin—Kardiologie, Diabetologie & Nephrologie, Evangelisches Klinikum Bethel, Burgsteig 13, 33617, Bielefeld, Germany

    Carsten W. Israel, Sona Tribunyan & Malik Kalyani

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  1. Carsten W. Israel
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  2. Sona Tribunyan
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  3. Malik Kalyani
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Correspondence to Carsten W. Israel.

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Conflict of interest

C.W. Israel: Medtronic (Advisory Board, Lecture fees, compensation for travelling and conference expenses). S. Tribunyan and M. Kalyani 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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Israel, C.W., Tribunyan, S. & Kalyani, M. His bundle pacing: troubleshooting at implantation. Herzschr Elektrophys 31, 160–176 (2020). https://doi.org/10.1007/s00399-020-00690-y

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