Scarà Antonio, Golia Paolo, Grieco Domenico, Borrelli Alessio, De Ruvo Ermenegildo, Bressi Edoardo, Politano Alessandro, De Luca Lucia, Bruni Giuseppe, Fagagnini Alessandro, Panuccio Marco, Rebecchi Marco, Zecchi Paolo, Solimene Francesco, Calò Leonardo, Sciarra Luigi
Policlinico Casilino Hospital Rome Italy.
NS della Mercede Hospital Rome Italy.
J Arrhythm. 2022 Dec 30;39(1):18-26. doi: 10.1002/joa3.12803. eCollection 2023 Feb.
His bundle pacing (HBP) may be a challenging procedure, often involving a long fluoroscopic time (FT) and a long procedural time (PT). We sought to evaluate whether the use of a new nonfluroscopic mapping (NFM) system, the KODEX-EPD, is able to reduce FT and PT when mapping is performed by the pacing catheter rather than an electrophysiological mapping catheter.
We included 46 consecutive patients (77 ± 8 years; 63% male) who underwent HBP; in 22 a NFM-guided procedure with the KODEX-EPD system was performed (group 1), whereas in 24 a conventional fluoroscopy-guided approach was used (group 2). Pacing indications were sick sinus syndrome in 13, atrioventricular block in 21, and cardiac resynchronization therapy in 12 cases. Both a lumen-less fixed helix lead and a stylet-driven extendable helix lead were used, respectively, in 24% and 76% of patients. HBP was successful in 22 patients (100%) in group 1 and 23 patients (96%) in group 2. The FT was significantly reduced in group 1 (183 ± 117 s vs 464.1 ± 352 s in group 2, = .012). There were no significant differences between groups in PT and other procedural outcomes.
The KODEX-EPD system may be safely used in HBP procedures. It is effective in reducing ionizing radiation exposure, as evidenced by the significant drop in FT, without increasing PT.
希氏束起搏（HBP）可能是一项具有挑战性的操作，通常需要较长的透视时间（FT）和较长的手术时间（PT）。我们试图评估使用一种新的非透视标测（NFM）系统——KODEX-EPD，在通过起搏导管而非电生理标测导管进行标测时，是否能够减少FT和PT。
我们纳入了46例连续接受HBP的患者（77±8岁；63%为男性）；其中22例采用KODEX-EPD系统进行NFM引导下的手术（第1组），而24例采用传统的透视引导方法（第2组）。起搏适应证为病态窦房结综合征13例、房室传导阻滞21例、心脏再同步治疗12例。分别有24%和76%的患者使用了无腔固定螺旋电极和带芯可延伸螺旋电极。第1组22例患者（100%）和第2组23例患者（96%）的HBP成功。第1组的FT显著降低（183±117秒，而第2组为464.1±352秒，P = 0.012）。两组在PT和其他手术结果方面无显著差异。
KODEX-EPD系统可安全用于HBP手术。它能有效减少电离辐射暴露，FT显著下降即证明了这一点，且不会增加PT。
