Improvement Of The Hipp's System Pacing Implant Technology And Its Application Research

Objective Conventional fluoroscopy guidance,permanent His-bundle pacing(HBP)usually involves high fluoroscopy exposure.This study aims to explore the feasibility of Ensite NavX system and compare its pacing parameters and fluoroscopy doses(FD)with that of conventional fluoroscopy guiding HBP.Methods A total of 30 patients receiving HBP from June to January 2019 were prospectively enrolled into this study(15 patients guided by conventional fluoroscopy and 15 patients by NavX system).Procedure time,FD,and pacing parameters were recorded at implant and 3-month follow-up.Results Fourteen patients(93.3%)underwent successful HBP using Ensite NavX system.The total FD was 1.4±0.5 mGy in NavX group and 16.1± 2.2 mGy in conventional group(P<0.001).The His lead FD was 0.4±0.3 mGy in NavX group and 12.5± 2.2 mGy in conventional group(P<0.001).Besides,the procedure time was significantly longer in the NavX group(70.4± 10.5 min)than in the conventional group(63.9±4.1 min)(P=0.048).But,there was no significant difference in His lead implanting time between the two groups(8.6± 2.7 min vs.7.5± 1.9 min,P=0.236)There was no significant difference in pacing parameters at implant and follow-up between the two groups.Conclusion Guided by Ensite NavX system,HBP is efficient with a significant reduction in fluoroscopy exposure.Objective His-bundle pacing(HBP)is a physiological pacing modality,but HBP implantation remains a challenge.This study explored the feasibility of using visualization of the tricuspid valve annulus(TVA)to locate the site for HBP.Methods During the lead placement in eight patients with symptomatic bradycardia,the TVA and tricuspid septal leaflet was revealed by contrast injection in the right ventricle under the fluoroscopic right anterior oblique view,and the target site for HBP was identified near the intersection of the tricuspid septal leaflet and the interventricular septum.On the basis of the imaging marker,the pacing lead was placed for HBP at either the atrial(aHBP)or ventricular side(vHBP).Results During the implantation,the pacing lead placement was attempted for aHBP in two patients,vHBP in five patients,and first for aHBP then vHBP in one patient.The aHBP was selective and had a capture threshold of 1.6 ± 0.5 V/1.0ms and R-wave amplitude of 1.2 ± 0.4 mV.Ventricular-side His bundle capture was selective in four patients and nonselective in two patients.The vHBP capture threshold was 0.8±0.4 V/1.0ms(P<0.05 vs.aHBP)and R-wave amplitude was 4.1±1.5 mV(P<0.05 vs.aHBP).At the final pacing programming of 3.0 V/1.0ms,vHBP was nonselective in all six patients and aHBP remained selective in two patients.Pacing parameters remained stable at 3 months,and no procedure-related complications were observed.Conclusion The location of the TVA and tricuspid septal leaflet revealed by right ventriculography can be used as a landmark to identify the HBP site.Objective While His bundle pacing(HBP)can be achieved in either atrial or ventricular side,the difference between atrial-side(a-HBP)and ventricular-side HBP(v-HBP)have not been systematically investigated.This study aims to compare the pacing parameters and electrophysiological characteristics between a-HBP and v-HBP in bradycardia patients.Methods Fifty patients undergoing HBP implantation assisted by visualization of the tricuspid valvular annnulus(TVA)were retrospectively analyzed.The TVA was used to identified a-HBP and v-HBP when the pacing lead was placed for HBP.Pacing parameters and echocardiography were routinely assessed at implant and 3-month follow-up.Results HBP was successfully performed in 45 patients(90%success rate with 44.4%a-HBP and 55.6%v-HBP).The capture threshold was lower in v-HBP than a-HBP at implant(v-HBP:1.1±0.5 vs.a-HBP:1.4±0.4 V/1.0ms,P=0.014)and 3-month follow-up(v-HBP:0.8±0.4 vs.a-HBP:1.7±0.8 V/0.4ms,P<0.001).The R-wave amplitude was higher in v-HBP than in a-HBP at implant(v-HBP:4.5 ± 1.4 vs.a-HBP:2.0 ± 0.8mV,P<0.001)and at 3-month follow-up(v-HBP:4.4 ± 1.5 vs.a-HBP:1.8 ± 0.7 mV,P<0.001).No aggravation of tricuspid valve regurgitation was observed in most patients and echocardiographic assessment of cardiac function remained in the normal range in all patients during the follow-up.Conclusions This study demonstrates that v-HBP features a low and stable pacing capture threshold and high R-wave amplitude without the incidence of atrial oversensing during the short-term follow-up,suggesting better pacing mode management and battery longevity can be achieved by HBP in the ventricular side.Objective Despite considerably promising merits,challenges with His-bundle pacing(HBP)still remain particularly in patients with enlarged cardiac chambers and advanced conduction disease.To assess the feasibility and outcomes of distal His-bundle pacing(DHRP)by tricuspid valve annulus(TVA)angiography in challenging HBP implants.Methods Thirty challenging HBP implants were attempted(15 underwent DHBP by TVA angiography and another 15 underwent conventional HBP).Challenging HBP implants was defined as the HBP under conventional fluoroscopy not be achieved after a His lead fluoroscopy time of 15 minutes(HB capture threshold was ≤2.5V/1.0ms;Pacing response was categorized as selective or non-selective HBP on the basis of HBP collaborative working group’s recommendations).Success rate,pacing parameters and echocardiographic data were peri operatively assessed and at 3-month follow-up.Results In the conventional group,HBP was successfully obtained in 5 of 15 patients,compared with the successful DHBP achieved in 12 of 15 patients.The success rate in DHBP was significantly higher than that in conventional HBP(80.0%vs.33.3%,P=0.025).The HB capture threshold and R-wave amplitude of DHBP were 1.66 ± 0.56 V/1.0ms and 5.5 ± 1.3 mV at implant and remained stable(1.48 ± 0.84 V/0.4ms,P=0.362)(6.0 ± 1.3 mV,P=0.160).during 3-month follow-up without procedure-related complications and tricuspid valve function affected.Cardiac function(51.7 ± 11.4 vs.54.7 ± 8.3%,P=0.017),left ventricular synchrony(83.9 ± 20.8 vs.58.9 ± 8.3 ms,P=0.002)in DHBP at 3-month follow-up significantly improved compared with that at baseline.Conclusion Permanent DHBRP is feasible and safely performed,resulting in a significantly higher success rate in challenging HBP implants compared with conventional HBP.DHBRP was associated with acceptable pacing parameters and favorable LV synchrony.Our preliminary results indicate that DHBRP may significantly increase the overall success of challenging HBP implants.Background Pacing the cardiac conduction system has been explored in patients with conduction system disease,but comprehensive comparisons between different pacing modalities are not well investigated.Objective To compare pacing characteristics and ventricular synchrony between His-bundle pacing(HBP)and left bundle branch pacing(LBBP)in patients with atrioventricular block(AVB).Methods Fifty pacemaker-indicated patients with AVB were enrolled.Twenty-five patients underwent HBP,and another 25 patients underwent LBBP.Success rate,procedural and fluoroscopy duration,pacing parameters and echocardiographic data were perioperatively assessed and at 3-month follow-up.Results HBP was successful in 19 of 25(76.0%)patients,whereas LBBP was successful in 22 of 25(88.0%)patients.The success rate was comparable between HBP and LBBP groups(76.0%vs.88.0%,P=0.462).Compared with HBP,LBBP capture threshold was significantly lower(0.76±0.25 V/0.4ms vs.1.27± 0.61 V/1.0ms,P=0.003)and R-wave amplitude was significantly higher with LBBP(11.7±6.6 vs.4.9± 2.4 mV,P<0.001)at implant.The mean procedural time(74.3± 17.8 vs.63.2± 12.3 min,P=0.029)and fluoroscopy duration(10.3±4.5 vs.6.8± 2.2 min,P=0.005)were significantly longer in the HBP group compared to LBBP.At 3-month follow-up,pacing capture threshold remained more stable in LBBP than in HBP group while left ventricular synchrony were similar between both groups(HBP:-7.4± 11.9 vs.LBBP:-6.1±6.7 ms,P=0.699).Conclusion Despite similar impact on ventricular synchrony compared with HBP,LBBP featured a significantly lower pacing capture threshold,higher R-wave amplitude and less time to achieve similar success rate in patients with AVB.These findings indicate LBBP as a physiological pacing strategy for AVB patients but long-term clinical outcomes and safety need further evaluation.