Open AccessHis bundle pacing – a curative method
Author(s) -
Cătălin Pestrea,
Alexandra Gherghina,
Florin Orțan,
Gabriel Cismaru,
Radu Roșu
Publication year - 2020
Publication title -
medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.59
H-Index - 148
eISSN - 1536-5964
pISSN - 0025-7974
DOI - 10.1097/md.0000000000021633
Subject(s) - medicine , qrs complex , cardiology , atrioventricular block , ventricular pacing , cardiac resynchronization therapy , cardiac pacing , bundle , electrical conduction system of the heart , heart block , lead (geology) , left bundle branch block , bundle branch block , electrocardiography , heart failure , materials science , ejection fraction , geomorphology , composite material , geology
Pacing of the His bundle and conduction system seems an attractive site for pacing. Lead placement in His-pacing might be technically challenging due to surrounding structures and particular anatomic location. Patient concerns: A 62-years old male patient was admitted for recurrent syncope. Electrocardiographic monitoring revealed periods of complete atrioventricular block with left branch block morphology and a QRS duration of 160 ms. Diagnosis: A diagnosis of intermittent complete atrioventricular block was made with a Class I indication of permanent dual-chamber cardiac pacing. Interventions: A lead delivery system with a C315 His catheter and a Select Secure 3830 69 cm pacing lead was placed at the septal area of the atrioventricular junction with good pacing and sensing thresholds. An important narowing of the QRS was observed. Outcomes: After the procedure, good pacing and sensing parameters were observed. Echocardiography revealed disappearance of the previously recorded ventricular dyssynchronism. Device follow-up at 1 month and 3 months showed stable pacing and sensing parameters. Conclusion: Pacing the distal His bundle normalized the QRS complex, therefore “curing” both the atrioventricular and the left bundle branch conduction abnormalities. As such, the technique can be used as an alternative to cardiac electrical resynchronization therapy with acceptable pacing and detection thresholds and better ventricular activation pattern.