Deep Negative Deflection in Unipolar His-Bundle Electrogram as a Predictor of Excellent His-Bundle Pacing Threshold Postimplant
| Autor: | Kyoko Soejima, Noriko Nonoguchi, Toshiaki Sato, Yosuke Miwa, Mika Tashiro, Ikuko Togashi, Kyoko Hoshida, Akiko Maeda, Yuichi Momose, Michitsugu Komeda, Akiko Ueda, Takato Mohri |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
Male
Bradycardia Bundle of His medicine.medical_specialty Time Factors Action Potentials Heart Rate Predictive Value of Tests Risk Factors Physiology (medical) Internal medicine Humans Medicine Prospective Studies Registries Atrioventricular Block His Bundle Electrogram Aged Aged 80 and over business.industry Cardiac Pacing Artificial medicine.disease Treatment Outcome Cardiology Female medicine.symptom Electrophysiologic Techniques Cardiac Cardiology and Cardiovascular Medicine business Atrioventricular block Intrinsic QRS Duration |
| Zdroj: | Circulation: Arrhythmia and Electrophysiology. 12 |
| ISSN: | 1941-3084 1941-3149 |
| DOI: | 10.1161/circep.119.007415 |
| Popis: | Background: His-bundle pacing (HBP) is a physiological form of pacing. Although high capture thresholds are common, few predictors of low HBP threshold have been determined. We aimed to identify electrophysiological predictors. Methods: Fifty-one patients (53% with atrioventricular block) underwent HBP for bradycardia with an intrinsic QRS duration of 6 months. Results: In total, 153 attempts at anchoring the HBP lead were made, of which, 45 achieved acceptable HBP thresholds (≤2.5 V at 1 ms). The amplitude of negative deflection in HB EGM and the selective HBP form at fixation were independently associated with achieving an acceptable threshold. A negative amplitude of ≥0.060 mV in HB EGM was determined as the optimal value for identifying the acceptable threshold. This deep negative HB EGM was recorded with an HBP threshold of 1.4±1.3 V (in 34 attempts), significantly lower than that of positive HB EGM without deep negative deflection (2.8±1.3 V, in 31 trials; or >5 V, in 38 trials). The permanent HBP lead remained with deep negative (≥0.060 mV) or positive HB EGMs in 28 and 14 patients, respectively, and with positive or negative HB injury current in 19 and 23 patients, respectively. During follow-up, increased HBP threshold of >1 V was significantly more prevalent in the positive HB EGM group. The HBP thresholds of deep negative HB EGM and HB injury current, but not of the selective HBP group, were significantly lower than the other subgroups during follow-up. Conclusions: Deep negative HB EGM at fixation was associated with an excellent short-term HBP threshold, similar to HB injury current. Analysis of unipolar HB EGM postfixation may enable prediction of permanent HBP threshold. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|