His bundle pacing for newly acquired pacing needs in patients implanted with a subcutaneous implantable cardioverter defibrillator: A feasibility study based on the automated screening score and clinical cases.

Gauthey, Anais;Calle, Simon;Accinelli, Stefano;Depuydt, Philippe;Le Polain De Waroux, Jean-Benoît;et.al.
(2020) Journal of Cardiovascular Electrophysiology — Vol. 31, n° 7, p. 1793-1800 (2020)

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Authors
  • Gauthey, Anaisorcid-logoUCLouvain
    Author
  • Calle, Simon
    Author
  • Accinelli, Stefano
    Author
  • Depuydt, Philippe
    Author
  • Garnir, QuentinUCLouvain
    Author
  • Scavée, ChristopheUCLouvain
    Author
  • Marchandise, SébastienUCLouvain
    Author
  • Wauters, AurélienUCLouvain
    Author
  • Le Polain De Waroux, Jean-Benoîtorcid-logoUCLouvain
    Author
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Abstract
INTRODUCTION: Management of subcutaneous implantable cardioverter defibrillator (S-ICD) patients with newly acquired pacing needs remains problematic. His bundle pacing (HBP) allows for cardiac pacing without significant changes in the QRS morphology. We hypothesized that HBP does not alter S-ICD sensing and functions. METHODS: Twenty consecutive patients were implanted with a HB pacemaker. Among them, 17 demonstrated successful His recruitment and were prospectively screened with the automated screening tool (AST). Results of screenings performed immediately after implant and during follow-up, during intrinsic rhythm and while pacing from all available pacing configurations, were compared using the AST score. Positive-screening tests were defined by greater than or equal to 1 positive vector. RESULTS: Among the 17 patients successfully implanted (male: 41%; mean age: 73), 13 presented an indication of ventricular pacing and four of cardiac resynchronization. Absolute AST scores during both HBP (all configurations) and intrinsic rhythm were similar (p: NS). Due to left bundle branch block correction, HBP resulted in higher number of positive vectors (AST ≥ 100). AST scores were higher during HBP when compared with right ventricular pacing (RVP) (primary vector: 272 [16; 648] vs 4.6 [0.8; 16.2]; P = .003; secondary vector: 569 [183; 1186] vs 1.5 [0.7; 8.3]; P < .0001; alternate vector: 44 [2;125] vs 4.8 [0.9; 9.3]; P = .02) and resulted in a much higher number of positive vectors. Up to 90% of the patients had a positive-screening test during HBP. This passing rate was higher when compared RVP (17%; P < .0001). CONCLUSION: HBP restores normal intrinsic conduction and minimally modifies the surface electrocardiograph and subcutaneous electrograms. When ventricular pacing is needed, HBP might represent an ideal pacing option for patients implanted with a S-ICD.
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Gauthey, A., Calle, S., Accinelli, S., Depuydt, P., Garnir, Q., Scavée, C., Marchandise, S., Wauters, A., Bordachar, P., de Pooter, J., & Le Polain De Waroux, J.-B. (2020). His bundle pacing for newly acquired pacing needs in patients implanted with a subcutaneous implantable cardioverter defibrillator: A feasibility study based on the automated screening score and clinical cases. Journal of Cardiovascular Electrophysiology, 31(7), 1793-1800. https://doi.org/10.1111/jce.14566 (Original work published 2020)