Department of Cardiovascular Medicine, Royal Melbourne Hospital, Melbourne, Vic, Australia.
Department of Cardiovascular Medicine, Royal Melbourne Hospital, Melbourne, Vic, Australia; Department of Medicine, University of Melbourne, Melbourne, Vic, Australia.
Heart Lung Circ. 2020 Oct;29(10):1493-1501. doi: 10.1016/j.hlc.2020.01.003. Epub 2020 Jan 30.
His-bundle pacing (HBP) has emerged as a promising technique to avoid pacing complications associated with dyssynchrony from right ventricular pacing, but data are limited to experienced operators and centres. We aimed to evaluate the implementation and outcomes of an HBP program in an Australian setting.
Data were retrospectively collected on 140 consecutive HBP procedures attempted at three centres from March 2018 to September 2019. The cohort was divided into three groups (early: procedures 1-47, middle: 48-94, late: 95-140) to determine changes in procedural success in relation to operator experience.
Median age was 76 years (IQR 68-80 yrs); 69% were male. Atrial fibrillation was present in 59%, left ventricular ejection fraction (LVEF) ≤40% in 25%, and left and right bundle branch blocks present in 23% and 16% respectively, and atrioventricular (AV) block was present in 26%. Overall procedural success was 87%, median implant threshold 0.8V@1 ms, and QRS duration improved in 64% of procedures. Procedural success (early 83%, middle 89%, late 89%, p=0.58) was not different, while median procedural time (early 98 mins, middle 83 mins, late 70 mins, p<0.001) improved across operator experience groups. Lower success rates were identified for patients with AV block (73% vs. 92%, p<0.01), a previous device (69% vs. 89%, p=0.02), moderate-severe TR (69% vs. 88%, p=0.04), and when right-sided access was required (25% vs. 89%, p<0.01).
His-bundle pacing is a feasible procedure with continued improvement in procedural measures of success after an early learning period. The presence of AV block, a previous device, significant tricuspid regurgitation, or right-sided access may affect procedural success.
希氏束起搏（HBP）已成为一种很有前途的技术，可以避免因右心室起搏导致的不同步而引起的起搏并发症，但数据仅限于经验丰富的操作者和中心。我们旨在评估在澳大利亚环境下实施 HBP 项目的情况和结果。
回顾性收集了 2018 年 3 月至 2019 年 9 月在三个中心进行的 140 例连续 HBP 手术的数据。该队列分为三组（早期：第 1-47 例；中期：第 48-94 例；晚期：第 95-140 例），以确定与操作者经验相关的手术成功率的变化。
中位年龄为 76 岁（IQR 68-80 岁）；69%为男性。59%存在心房颤动，25%左心室射血分数（LVEF）≤40%，23%和 16%分别存在左束支和右束支传导阻滞，26%存在房室（AV）阻滞。总体手术成功率为 87%，中位植入阈值为 0.8V@1ms，64%的手术 QRS 时限改善。手术成功率（早期 83%，中期 89%，晚期 89%，p=0.58）无差异，而操作者经验组的中位手术时间（早期 98 分钟，中期 83 分钟，晚期 70 分钟，p<0.001）逐渐缩短。AV 阻滞患者（73%比 92%，p<0.01）、有先前设备（69%比 89%，p=0.02）、中重度三尖瓣反流（69%比 88%，p=0.04）和需要右侧入路（25%比 89%，p<0.01）的患者成功率较低。
希氏束起搏是一种可行的方法，在早期学习阶段后，手术成功率的各项指标持续改善。AV 阻滞、先前设备、严重三尖瓣反流或右侧入路可能会影响手术成功率。
