Mohan Ayush, Lee Jenna, Adams Whitney, Phillips Brittany, Hakes Sharon, Mahmud Rehan
McLaren Bay Heart and Vascular, McLaren Bay Region Hospital, Bay City, Michigan.
Heart Rhythm O2. 2025 Apr 25;6(7):956-959. doi: 10.1016/j.hroo.2025.04.010. eCollection 2025 Jul.
High capture thresholds and lead dislodgment are often cited as impediments for general adoption of His bundle pacing.
We report on our experience in managing patients who underwent His bundle pacing with higher energy requirement and incidence of lead dislodgment in a mean duration of 33 months.
In 1188 patients, pacing was done at the site of His bundle electrogram and capture of conduction axis was confirmed by paced complex demonstrating normal or more normal QRS voltage, QRS axis, and ventricular activation time. Patients were followed for 33 months with routine programming changes to optimize battery longevity.
His bundle pacing thresholds revealed a small but significant increase in His bundle capture (from 1.1 ± 0.8 to 1.3 ± 0.8 [ < .001]). However, with optimization of pulse duration and pacing polarity, the capture threshold energy for the group, remained unchanged at 0.003 mJ from 4 weeks to 33 months. Two volts or higher threshold was found in 92 patients (11%) at 4 weeks and in 151 patients (16%) at 33 months. The average predicted battery life was 8.5 years. Lead dislodgment occurred in 15 patients (1.2%).
In His bundle pacing, the increase in capture threshold over time can be managed by optimizing pacing pulse duration and polarity. The dislodgment rates of Medtronic 3830 lead are not unlike those reported for myocardial pacing. Our study calls attention to the >2 V threshold in 16% of patients and the need for higher output pacemaker batteries.
高捕捉阈值和导线脱位常被视为阻碍希氏束起搏广泛应用的因素。
我们报告了在平均33个月的时间里，对接受希氏束起搏且能量需求较高和导线脱位发生率较高的患者的管理经验。
在1188例患者中，在希氏束电图部位进行起搏，并通过起搏复合波证实传导轴的捕捉，起搏复合波显示正常或更正常的QRS电压、QRS轴和心室激动时间。对患者进行了33个月的随访，定期进行程控调整以优化电池寿命。
希氏束起搏阈值显示希氏束捕捉有小幅但显著的增加（从1.1±0.8增至1.3±0.8[<.001]）。然而，通过优化脉宽和起搏极性，该组的捕捉阈值能量从4周持续到33个月保持在0.003 mJ不变。4周时92例患者（11%）、33个月时151例患者（16%）的阈值为2伏或更高。平均预测电池寿命为8.5年。15例患者（1.2%）发生导线脱位。
在希氏束起搏中，随着时间推移捕捉阈值的增加可通过优化起搏脉宽和极性来控制。美敦力3830导线的脱位率与心肌起搏报道的脱位率无异。我们的研究提醒注意16%的患者阈值>2 V以及对高输出起搏器电池的需求。
