Division of Advanced Arrhythmia Management, Kyorin University School of Medicine, Mitaka, Japan.
Department of Cardiovascular Medicine, Kyorin University School of Medicine, Mitaka, Japan.
JACC Clin Electrophysiol. 2021 Apr;7(4):513-521. doi: 10.1016/j.jacep.2020.09.018. Epub 2020 Dec 24.
This study investigated the differences between distal His bundle pacing (HBP) via the right ventricle and proximal HBP via the right atrium with regard to pacing and sensing parameters.
HBP preserves physiological ventricular activation. The capture threshold of the adjacent ventricle accompanying HBP has not been evaluated after implantation.
Fifty patients with bradycardia (58% with atrioventricular block) underwent successful HBP and were followed for 1 year. Precise locations of the lead tips were confirmed using follow-up echocardiography.
HBP leads were fixed via the right atrium or right ventricle (25 patients each). Overall, the local ventricle and HBP thresholds were elevated during follow-up. The distal HBP thresholds did not significantly differ from the proximal HBP thresholds, although local ventricular thresholds of distal HBP were markedly lower than those of proximal HBP. At 6 months, the accepted ventricular threshold (≤2.5 V) was maintained in 39 patients (78%). An amplitude of ventricular electrogram post-fixation of ≥2.0 mV and a capture threshold of ≤1.1 V at implantation were determined to be optimal values for predicting the accepted threshold at 6 months, with areas under the curve of 0.86 and 0.84, respectively. Atrial oversensing was often detected in proximal HBP but not distal HBP.
Distal HBP via the right ventricle captured the His bundle, similar to proximal HBP via the right atrium, with a superior local ventricular threshold during follow-up. Anatomy and electrophysiological ventricular properties at implantation may be critical for maintaining adjacent ventricle capture to prevent lead revision (Evaluation of Electrophysiological Parameters related to His Bundle Pacing in Patients With Bradyarrhythmias; UMIN000031364).
本研究旨在比较右心房近端希氏束起搏（HBP）与右心室远端 HBP 起搏在起搏和感知参数方面的差异。
HBP 保留了生理性心室激动。但植入后，邻近心室伴随 HBP 的夺获阈值尚未得到评估。
50 例心动过缓患者（58%为房室传导阻滞）成功接受了 HBP 治疗，并进行了为期 1 年的随访。通过后续超声心动图确认导线尖端的精确位置。
HBP 导线通过右心房或右心室固定（各 25 例）。总的来说，在随访过程中，局部心室和 HBP 阈值均升高。尽管远端 HBP 的局部心室阈值明显低于近端 HBP，但远端 HBP 的阈值与近端 HBP 无显著差异。在 6 个月时，39 例（78%）患者维持了可接受的心室阈值（≤2.5V）。固定后心室电图振幅≥2.0mV 和植入时夺获阈值≤1.1V 被确定为预测 6 个月时可接受阈值的最佳值，曲线下面积分别为 0.86 和 0.84。近端 HBP 常检测到心房过感知，但在远端 HBP 中则不然。
右心室远端 HBP 与右心房近端 HBP 一样，能够捕获希氏束，在随访过程中具有较高的局部心室阈值。植入时的解剖结构和电生理心室特性对于维持邻近心室夺获以防止导线修改可能至关重要。
