Geisinger Heart Institute, Wilkes-Barre, Pennsylvania, USA.
Division of Cardiology, Division of Cardiac Electrophysiology, Indiana University, Indianapolis, Indiana, USA.
JACC Clin Electrophysiol. 2021 Jan;7(1):73-84. doi: 10.1016/j.jacep.2020.07.026. Epub 2020 Sep 30.
This study sought to evaluate the correlation between His bundle (HB) pacing (HBP) implantation characteristics, lead-tip location, and association of intraprocedural His recordings with approximated HB anatomic landmarks using computed tomography (CT) imaging.
HBP continues to grow in clinical practice due to offering true physiological pacing. However, a clear understanding of HB anatomy and the lead-tip location's influence on pacing characteristics is lacking.
The IMAGE-HBP study (Imaging Study of Lead Implant for His Bundle Pacing) was a prospective, multicenter study designed to assess implantation characteristics of the SelectSecure Model 3830 lead placed at the HB, evaluate protocol-specified HBP success (His recording present on electrogram and HBP threshold ≤2.5 V at 1 ms), and correlation between lead-tip location by CT imaging and HBP characteristics as well as lead-related complications through 12 months.
Sixty-nine patients underwent a lead implantation attempt at the HB. Of these, 61 patients (88%) had a lead successfully implanted at the HB, and 52 patients (75%) met the pre-specified definition of successful HBP. In 51 patients with CT imaging, 11 leads (22%) were placed in the atrial aspect of the HB region (36% selective HBP), and 40 leads (78%) were placed in the ventricular aspect (28% selective HBP). Four of the 51 patients had P-wave oversensing, all with leads in the atrium. Freedom from lead-related complication at 12 months was 93%.
Successful HBP could be achieved at lead-tip locations in the atrium or ventricle but is preferable in the ventricle to eliminate risk of oversensing. The IMAGE-HBP study offers better insight into approximated HB anatomic landmarks, lead-tip location, and correlation with pacing characteristics. (Imaging Study of Lead Implant for His Bundle Pacing [IMAGE-HBP]; NCT03294317).
本研究旨在评估希氏束（HB）起搏（HBP）植入特征、导线尖端位置，以及使用计算机断层扫描（CT）成像的术中 HB 记录与 HB 解剖标志的近似位置之间的相关性。
由于提供真正的生理起搏，HBP 在临床实践中不断发展。然而，对 HB 解剖结构的理解以及导线尖端位置对起搏特征的影响还不清楚。
IMAGE-HBP 研究（希氏束起搏导线植入的影像学研究）是一项前瞻性、多中心研究，旨在评估 SelectSecure Model 3830 导线在 HB 中的植入特征，评估方案规定的 HBP 成功（心电图上存在 HB 记录，HBP 阈值≤2.5V，1ms），以及通过 12 个月评估 CT 成像时导线尖端位置与 HBP 特征以及导线相关并发症之间的相关性。
69 例患者在 HB 进行了导线植入尝试。其中，61 例（88%）患者 HB 导线成功植入，52 例（75%）患者达到了预先规定的成功 HBP 定义。在 51 例有 CT 成像的患者中，11 根导线（22%）置于 HB 区域的心房侧（36%选择性 HBP），40 根导线（78%）置于心室侧（28%选择性 HBP）。51 例患者中有 4 例发生 P 波过感知，均为心房导线。12 个月时导线相关并发症的无发生率为 93%。
在心房或心室的导线尖端位置可以实现成功的 HBP，但在心室中更可取，以消除过感知的风险。IMAGE-HBP 研究提供了对 HB 解剖标志、导线尖端位置以及与起搏特征的相关性的更好的了解。（希氏束起搏导线植入的影像学研究[IMAGE-HBP]；NCT03294317）。
