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Bundle of his pacing

Marek Sramko, Dan Wichterle, Josef Kautzner
This study evaluated hemodynamic feasibility and reproducibility of a new method for in vivo simulation of human atrial fibrillation (AF). The method was tested during sinus rhythm in 10 patients undergoing catheter ablation for AF. A simple electronic device was assembled that allowed triggering a cardiac stimulator by predefined series of RR intervals. Irregular RR interval sequences with a mean heart rate of 90/min and 130/min were obtained from ECG recordings of another patients with AF. Simultaneous atrioventricular pacing was delivered by catheters placed inside the coronary sinus and at the His bundle region...
2016: PloS One
Gopi Dandamudi, Pugazhendhi Vijayaraman
Chronic right ventricular (RV) pacing has been shown over the years to exert detrimental physiological changes including increased risk for heart failure and atrial fibrillation. His bundle pacing offers the promise of physiological activation of the ventricular tissue, with the potential for reducing the detrimental effects of RV pacing. We describe His bundle pacing in a historical context and briefly highlight several clinical trials that have helped shape the landscape of permanent His bundle pacing.
September 24, 2016: Journal of Electrocardiology
Parikshit S Sharma, Faiz A Subzposh, Kenneth A Ellenbogen, Pugazhendhi Vijayaraman
BACKGROUND: Conduction disease is not uncommon after prosthetic valve (PV) surgery. The feasibility of His bundle pacing (HBP) in this patient (pt) population is not well studied. OBJECTIVE: We report our experience with permanent HBP in pts undergoing pacemaker (PM) implantation following PV surgery. METHODS: Permanent HBP was attempted in pts with AV conduction disease post PV surgery referred for PM implantation. Conduction disease was characterized as AV nodal vs infra-nodal...
September 20, 2016: Heart Rhythm: the Official Journal of the Heart Rhythm Society
Amrish Deshmukh, Pramod Deshmukh
Direct His bundle pacing provides the most physiologic means of artificial pacing of the ventricles with a preserved His-Purkinje system and may play a role in patients with a diseased intrinsic conduction system. We describe our initial motivations and experience with permanent direct His bundle pacing and important lessons learned since that time.
September 2016: Journal of Electrocardiology
Asit Das, Dhiman Kahali
Adverse hemodynamics of right ventricular (RV) pacing is a well-known fact. It was believed to be the result of atrio-ventricular (AV) dyssynchrony and sequential pacing of the atrium and ventricle may solve these problems. However, despite maintenance of AV synchrony, the dual chamber pacemakers in different trials have failed to show its superiority over single chamber RV apical pacing in terms of death, progression of heart failure, and atrial fibrillation (AF). As a consequence, investigators searched for alternate pacing sites with a more physiological activation pattern and better hemodynamics...
July 2016: Indian Heart Journal
Benjamin J Scherlag, Ralph Lazzara
In this review we present evidence from many experimental studies which challenge the concept of predestination of His bundle fibers. Using both intra- and extracellular His bundle pacing in the context of atrio-ventricular block and the development of bundle branch blocks these experimental studies provide the underlying mechanisms for the recent clinical findings showing the benefits of permanent His bundle pacing.
July 16, 2016: Journal of Electrocardiology
Siva K Mulpuru, Yong-Mei Cha, Samuel J Asirvatham
Right ventricular apical pacing is associated with an increased incidence of heart failure, atrial fibrillation, and overall mortality. As a result, pacing the ventricles in a manner that closely mimics normal AV conduction with an intact His-Purkinje system has been explored. Recently, the sustainable benefits of selective His-bundle stimulation have been demonstrated and proposed as the preferred method of ventricular stimulation for appropriate patients. Ideally, conduction system pacing should be selective without myocardial capture, overcome distal bundle branch block when present, and not compromise tricuspid valve function...
August 3, 2016: Heart Rhythm: the Official Journal of the Heart Rhythm Society
Alexandra E Teng, Louis Massoud, Olujimi A Ajijola
His bundle pacing is increasingly used to avoid chronic right ventricular pacing, and electrically resynchronize ventricular activation by narrowing or normalizing the QRS interval in left and right bundle branch block. The mechanisms by which this occurs remain poorly understood. In this review, the proposed mechanisms and evidence supporting them are discussed. Also discussed are aspects of mechanisms that are not completely supported by the evidence. We also review the differences and physiological bases for direct vs...
September 2016: Journal of Electrocardiology
Daniel J Friedman, Markus Hjorth, Albert Y Sun, Brett D Atwater
We present a case of a patient with elevated His lead capture thresholds and intermittent recruitment of the left bundle. The patient underwent a non-invasive electrophysiology study and was determined to have a left bundle branch block due to post-repolarization refractoriness. The nature of bundle branch block can have important implications for optimal patient selection and device programming in the emerging field of His bundle pacing. This article is protected by copyright. All rights reserved.
August 1, 2016: Journal of Cardiovascular Electrophysiology
Gopi Dandamudi, Pugazhendhi Vijayaraman
In this paper, we describe the anatomy and physiology of the His bundle and describe the mechanisms by which permanent His bundle pacing can be accomplished. This article is protected by copyright. All rights reserved.
July 29, 2016: Pacing and Clinical Electrophysiology: PACE
Pugazhendhi Vijayaraman, Gopi Dandamudi, Kenneth A Ellenbogen
BACKGROUND: Permanent His bundle pacing (HBP) is a physiological alternative to right ventricular pacing (RVP). Catheter manipulation during HBP can cause trauma to the His bundle during implantation. We sought to determine acute and long-term incidence of His bundle (HB) injury with HBP. METHODS: Patients undergoing permanent HBP at Geisinger Wyoming Valley Medical Center from 2006 to 2014 formed the study group. Patients with pre-existing His-Purkinje disease (HPD) were excluded from the study...
September 2016: Journal of Electrocardiology
Pugazhendhi Vijayaraman, Gopi Dandamudi
Permanent His bundle pacing is a physiological alternative to right ventricular pacing. In this article we describe our approach to His bundle pacing in patients with AV nodal and intra-Hisian conduction disease. It is essential for the implanters to understand the anatomic variations of the His bundle course and its effect on the type of His bundle pacing achieved. We describe several case examples to illustrate our anatomical approach to permanent His bundle pacing in this article.
September 2016: Journal of Electrocardiology
Alexandra E Teng, Daniel L Lustgarten, Pugazhendhi Vijayaraman, Roderick Tung, Kalyanam Shivkumar, Galen S Wagner, Olujimi A Ajijola
His Bundle pacing (HBP) restores electrical synchronization in left bundle branch block (LBBB); however, the underlying mechanisms are poorly understood. We examined the relation between native QRS axis in LBBB, a potential indicator of the site of block, and QRS normalization in patients with LBBB. Data from patients (n = 41) undergoing HBP at 3 sites were studied (68 ± 13 years, 13 women). Study criteria included strictly defined complete LBBB and successful implantation of a permanent HBP lead. Preprocedure and postprocedure electrocardiograms were reviewed independently by 2 blinded readers...
August 15, 2016: American Journal of Cardiology
Rakesh Jain, Sandeep Mohanan, Vellini Haridasan, Gopalan Nair Rajesh, Krishnan Mangalath Narayanan, Kalathingathodika Sajeer
A 74-year-old man with symptomatic complete heart block underwent right ventricular apical permanent pacemaker implantation. The postoperative ECG showed, as expected, completely paced left bundle branch block QRS morphology. However, at the 2-month follow-up examination, his ECG showed paced right bundle branch block (RBBB) QRS morphology, although the patient was asymptomatic. On evaluation, pacemaker functioning was normal with no evidence of lead displacement. This case report highlights that RBBB morphology of paced QRS complex is not always a red flag sign...
2014: Heart Asia
Mads Brix Kronborg, Jens Cosedis Nielsen
Traditional right ventricular pacing prolongs the electrical and mechanical activation of the heart, which reduces the pump function, and in selected patients may lead to pacing-induced heart failure. Pacing the His bundle preserves the normal or near-normal activation pattern of the ventricles that prevents the detrimental effects of right ventricular pacing. This review discusses the techniques, feasibility, outcomes, and clinical impact of permanent His bundle pacing in patients with an indication for a cardiac implantable electronic device...
July 2016: Current Cardiology Reports
Pugazhendhi Vijayaraman, Gopi Dandamudi
Right ventricular pacing can cause ventricular dyssynchrony and result in reduced left ventricular systolic function and heart failure. Permanent His bundle pacing is a more physiologic form of pacing, but can be technically challenging. In this article, we describe our technique for permanent His bundle pacing including special considerations and limitations associated with His bundle pacing.
June 7, 2016: Pacing and Clinical Electrophysiology: PACE
Luigi Padeletti, Paolo Pieragnoli, Giuseppe Ricciardi, Lisa Innocenti, Luca Checchi, Margherita Padeletti, Antonio Michelucci, Francesco Picariello, Sergio Valsecchi
BACKGROUND: Previous studies have investigated the role of intrinsic conduction in optimizing cardiac resynchronization therapy. We investigated the role of fusing pacing-induced activation and intrinsic conduction in cardiac resynchronization therapy by evaluating the acute hemodynamic effects of simultaneous His-bundle (HIS) and left ventricular (LV) pacing. METHODS AND RESULTS: We studied 11 patients with systolic heart failure and left bundle-branch block scheduled for cardiac resynchronization therapy implantation...
May 2016: Circulation. Arrhythmia and Electrophysiology
Marek Jastrzebski, Maciej Pitak, Andrzej Rudzinski, Danuta Czarnecka
No abstract text is available yet for this article.
September 2016: Journal of Cardiovascular Electrophysiology
Atsushi Doi, Masahiko Takagi, Kouhei Fujimoto, Jun Kakihara, Yusuke Hayashi, Hiroaki Tatsumi, Minoru Yoshiyama
A 71-year-old man with palpitation was referred for electrophysiological study and radiofrequency ablation. Baseline findings of 12-lead electrocardiogram during sinus rhythm and echocardiography were normal. Atrio-His (AH) and His-ventricular (HV) intervals were measured as 113 and 40 ms, respectively. Dual atrioventricular (AV) nodal physiology was observed during programmed atrial stimulation. The earliest atrial activation during ventricular constant pacing was recorded at His bundle region, and para-Hisian pacing showed AV nodal pattern...
April 19, 2016: Journal of Cardiovascular Electrophysiology
Peiren Shan, Lan Su, Xiao Chen, Lei Xu, Xianda Ni, Weijian Huang
The optimal pacing modality after atrioventricular junction (AVJ) ablation remains unclear. Herein, we describe the case of a heart failure patient who had AVJ ablation for chronic atrial fibrillation and received a cardiac resynchronization therapy defibrillator device. Because of the lack of clinical response to biventricular pacing, the device was revised with the addition of direct His bundle pacing, which resulted in significant improvement in functional status and left ventricular indices. This case illustrated direct His bundle pacing as an alternative for conventional biventricular pacing in some cardiac resynchronization therapy nonresponders who undergo AVJ ablation for atrial fibrillation and have an intact distal conduction system...
November 10, 2015: Canadian Journal of Cardiology
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