Jastrzębski Marek, Moskal Paweł, Bednarek Agnieszka, Kiełbasa Grzegorz, Czarnecka Danuta
First Department of Cardiology, Interventional Electrocardiology and Hypertension, Medical College, Jagiellonian University, Krakow, Poland.
Pacing Clin Electrophysiol. 2018 Nov;41(11):1508-1512. doi: 10.1111/pace.13490. Epub 2018 Sep 19.
His-bundle (HB) pacing is the most physiological method of ventricular pacing. However, it is also considered a demanding procedure with a low success rate and has suboptimal pacing parameters. There is a scarcity of data concerning HB pacing as a standard approach in patients with symptomatic bradycardia. Our goal was to compare acute and chronic results of two approaches to pacing in patients with permanent atrial fibrillation, narrow QRS complexes, and symptomatic bradycardia: right ventricular myocardial pacing versus HB pacing.
Consecutive patients who received HB pacemakers were compared with historical controls-i.e., consecutive patients with classic VVI pacemaker implantations, performed by the same operator before 2014 (commencement of routine HB implantations). Acute and long-term capture threshold, sensing, battery current drain, as well as procedure and fluoroscopy duration, complications, and success rate were compared.
One hundred and twenty-five patients were analyzed (including 65 patients with HB pacing): age 73.0 ± 10.5 years, left ventricular ejection fraction of 48.2 ± 13.5%. HB pacing was inferior to right ventricular myocardial pacing in terms of higher threshold, lower sensing amplitude, higher current drain, lower success rate, longer procedure, and fluoroscopy times. However, despite this, HB procedure and fluoroscopy times of 64.4 ± 30.0 and 11.0 ± 10.7 minutes, respectively, long-term successful HB pacing in 87.9% of patients, a chronic threshold of 1.5 ± 1.1 V, chronic sensing of 3.6 ± 2.5 mV, and chronic current drain per pulse of 3.4 ± 4.4 μAh seem acceptable.
HB pacing can be used as an alternative standard method of pacing in atrial fibrillation patients.
希氏束（HB）起搏是心室起搏最符合生理的方法。然而，它也被认为是一项要求高、成功率低且起搏参数欠佳的操作。关于HB起搏作为有症状心动过缓患者的标准治疗方法的数据较少。我们的目标是比较两种起搏方法对永久性房颤、窄QRS波群且有症状心动过缓患者的急性和慢性结果：右心室心肌起搏与HB起搏。
将接受HB起搏器的连续患者与历史对照进行比较，即2014年（常规HB植入开始）之前由同一名操作者进行经典VVI起搏器植入的连续患者。比较急性和长期的起搏阈值、感知、电池电流消耗，以及手术和透视时间、并发症和成功率。
共分析了125例患者（包括65例接受HB起搏的患者）：年龄73.0±10.5岁，左心室射血分数48.2±13.5%。在阈值较高、感知幅度较低、电流消耗较高、成功率较低、手术时间较长和透视时间较长方面，HB起搏不如右心室心肌起搏。然而，尽管如此，HB手术和透视时间分别为64.4±30.0分钟和11.0±10.7分钟，87.9%的患者长期HB起搏成功，慢性阈值为1.5±1.1V，慢性感知为3.6±2.5mV，每次脉冲的慢性电流消耗为3.4±4.4μAh，这些似乎是可以接受的。
HB起搏可作为房颤患者起搏的替代标准方法。
