Heart Center, Gent University Hospital, Ghent, Belgium.
Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St-Luc, Université Catholique de Louvain, Brussels, Belgium.
J Cardiovasc Electrophysiol. 2020 Apr;31(4):813-821. doi: 10.1111/jce.14371. Epub 2020 Feb 5.
Conduction disorders requiring permanent pacemaker implantation occur frequently after transcatheter aortic valve replacement (TAVR). This multicenter study explored the feasibility and safety of His bundle pacing (HBP) in TAVR patients with a pacemaker indication to correct a TAVR-induced left bundle branch block (LBBB).
Patients qualifying for a permanent pacemaker implant after TAVR were planned for HBP implant. HBP was performed using the Select Secure (3830; Medtronic) pacing lead, delivered through a fixed curve or deflectable sheath (C315HIS or C304; Medtronic). Successful HBP was defined as selective or nonselective HBP, irrespective of LBB recruitment. Successful LBBB correction was defined as selective or nonselective HBP resulting in paced QRS morphology similar to pre-TAVR QRS and paced QRS duration (QRSd) less than 120 milliseconds with thresholds less than 3.0 V at 1.0-millisecond pulse width.
The study enrolled 16 patients requiring a permanent pacemaker after TAVR (age 85 ± 4 years, 31% female, all LBBB; QRSd: 161 ± 14 milliseconds). Capture of the His bundle was achieved in 13 of 16 (81%) patients. HBP with LBBB correction was achieved in 11 of 16 (69%) and QRSd narrowed from 162 ± 14 to 99 ± 13 milliseconds and 134 ± 7 milliseconds during S-HBP and NS-HBP, respectively (P = .005). At implantation, mean threshold for LBBB correction was 1.9 ± 1.1 V at 1.0 millisecond. Thresholds remained stable at 11 ± 4 months follow-up (1.8 ± 0.9 V at 1.0 millisecond, P = .231 for comparison with implant thresholds). During HBP implant, one temporary complete atrioventricular block occurred.
Permanent HBP is feasible in the majority of patients with TAVR requiring a permanent pacemaker with the potential to correct a TAVR-induced LBBB with acceptable pacing thresholds.
经导管主动脉瓣置换术（TAVR）后常需要植入永久性起搏器以治疗传导障碍。本多中心研究旨在探讨希氏束起搏（HBP）治疗 TAVR 后伴起搏器适应证的左束支传导阻滞（LBBB）患者的可行性和安全性。
TAVR 后需要植入永久性起搏器的患者计划行 HBP 植入。使用 SelectSecure（3830；美敦力）起搏导线经固定弯或可弯曲鞘（C315HIS 或 C304；美敦力）进行 HBP。成功的 HBP 定义为选择性或非选择性 HBP，无论 LBB 募集情况如何。成功纠正 LBBB 定义为选择性或非选择性 HBP，导致起搏 QRS 形态与 TAVR 前 QRS 相似，起搏 QRS 时限（QRSd）小于 120 毫秒，阈值小于 3.0 V，脉冲宽度为 1.0 毫秒。
本研究纳入 16 例 TAVR 后需要植入永久性起搏器的患者（年龄 85±4 岁，31%为女性，均为 LBBB；QRSd：161±14 毫秒）。16 例患者中有 13 例（81%）成功捕获希氏束。16 例患者中有 11 例（69%）行 HBP 并成功纠正 LBBB，QRSd 在 S-HBP 和 NS-HBP 时分别从 162±14 降至 99±13 毫秒和 134±7 毫秒（P=0.005）。植入时，LBBB 校正的平均阈值为 1.9±1.1 V，脉宽 1.0 毫秒。11 个月随访时阈值保持稳定（1.8±0.9 V，脉宽 1.0 毫秒，与植入阈值相比 P=0.231）。在 HBP 植入过程中，1 例患者发生一过性完全性房室传导阻滞。
TAVR 后需要植入永久性起搏器且伴 LBBB 的患者中，大多数患者行永久性 HBP 是可行的，且具有纠正 TAVR 诱导的 LBBB 的潜力，起搏阈值可接受。
