Ortega Daniel1, Logarzo Emilio2, Barja Luis2, Paolucci Analía2, Mangani Nicolás2, Eduardo Mazzetti3, María Paula Bonomini4. 1. Clínica San Camilo, Buenos Aires, Argentina; Fundación de Investigaciones Biomédicas Aplicadas, Buenos Aires, Argentina. Electronic address: ortecu@uolsinectis.com.ar. 2. Clínica San Camilo, Buenos Aires, Argentina; Fundación de Investigaciones Biomédicas Aplicadas, Buenos Aires, Argentina. 3. Sanatorio de la Trinidad, San Isidro, Argentina. Electronic address: hmazzetti@intramed.net. 4. Instituto Argentino de Matemática, 'Alberto P. Calderón' CONICET, Buenos Aires, Argentina; Instituto de Ingeniería Biomédica, Facultad de Ingeniería, UBA, Argentina. Electronic address: paula.bonomini@conicet.gov.ar.
Abstract
BACKGROUND: His Bundle pacing (HBP) preserves native ventricular activation through His Purkinje. Unfortunately, most current techniques for HBP implants require sheaths, special leads, and an electrophysiology setup for electrogram recording. METHODS: We developed an implantation technique guided by a non-invasive assessment of left ventricular electrical delay (LVED) as a measure of intraventricular dyssynchrony. The objective was to evaluate the usefulness and safety of this technique for implants of pacemakers and ICDs with right ventricular septal pacing (RVSP) using conventional screw-in leads and compare it with a reduced group of HBP (n = 32) guided by His potential mapping. 208 patients eligible for ventricular stimulation were implanted. Conventional screw-in leads were used in all cases. To ensure mechanical stability, stylets required a slight reshaping at the tip RESULTS: RVSP normalized electrical activity in patients with conduction disease, producing NS-HBP-like patterns. The parameters evaluated during implantation for the RVSP group were better than those of HBP and remained constant at a twelve months follow-up. In proportion, the number of dislodgments and the need for CRT upgrade was lower for RVSP than for HBP. Additionally, fluoroscopy time was significantly reduced in the RVSP group. CONCLUSIONS: This technique successfully guided RVSP implants in a non-invasive way and represents a simple alternative to the implant of a cardiac stimulation device.
BACKGROUND:His Bundle pacing (HBP) preserves native ventricular activation through His Purkinje. Unfortunately, most current techniques for HBP implants require sheaths, special leads, and an electrophysiology setup for electrogram recording. METHODS: We developed an implantation technique guided by a non-invasive assessment of left ventricular electrical delay (LVED) as a measure of intraventricular dyssynchrony. The objective was to evaluate the usefulness and safety of this technique for implants of pacemakers and ICDs with right ventricular septal pacing (RVSP) using conventional screw-in leads and compare it with a reduced group of HBP (n = 32) guided by His potential mapping. 208 patients eligible for ventricular stimulation were implanted. Conventional screw-in leads were used in all cases. To ensure mechanical stability, stylets required a slight reshaping at the tip RESULTS: RVSP normalized electrical activity in patients with conduction disease, producing NS-HBP-like patterns. The parameters evaluated during implantation for the RVSP group were better than those of HBP and remained constant at a twelve months follow-up. In proportion, the number of dislodgments and the need for CRT upgrade was lower for RVSP than for HBP. Additionally, fluoroscopy time was significantly reduced in the RVSP group. CONCLUSIONS: This technique successfully guided RVSP implants in a non-invasive way and represents a simple alternative to the implant of a cardiac stimulation device.
Authors: Andres Di Leoni Ferrari; Guilherme Ferreira Gazzoni; Luis Manuel Ley Domingues; Jessica Caroline Feltrin Willes; Gustavo Chiari Cabral; Flavio Vinicius Costa Ferreira; Laura Orlandini Lodi; Gustavo Reis Journal: Arq Bras Cardiol Date: 2022-02 Impact factor: 2.000