Permanent His-bundle pacing in patients with prosthetic cardiac valves

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• 作者：Parikshit S. Sharma ; MD ; MPH^* ; Faiz A. Subzposh ; MD^&dagger ; ; Kenneth A. Ellenbogen ; MD ; FHRS^* ; Pugazhendhi Vijayaraman ; MD ; FHRS^&dagger ; ; ^{pvijayaraman1@geisinger.edu}
• 关键词：His-Bundle pacing ; Prosthetic cardiac valves ; Bundle branch block ; Permanent pacemaker implant ; Tricuspid valve annuloplasty ; Aortic valve replacement ; Mitral valve replacement
• 刊名：Heart Rhythm
• 出版年：2017
• 出版时间：January 2017
• 年：2017
• 卷：14
• 期：1
• 页码：59-64
• 全文大小：1928 K
• 卷排序：14

文摘

Conduction disease is not uncommon after prosthetic valve (PV) surgery. The feasibility of His-bundle pacing (HBP) in this patient population is not well studied.ObjectiveThe purpose of this study was to report our experience with permanent HBP in patients undergoing pacemaker implantation after PV surgery.MethodsPermanent HBP was attempted in patients with AV conduction disease after PV surgery referred for pacemaker implantation. Conduction disease was characterized as AV nodal vs infranodal. Feasibility, relationship of HBP lead to PVs, and HBP characteristics were recorded.ResultsThirty patients (47% men, age 74 ± 12 years, left ventricular ejection fraction 49% ± 11%) with AV conduction disease (100% patients; 14 with infranodal block; right bundle branch block 9, left bundle branch block 5, intraventricular conduction delay 1) underwent HBP. PVs included aortic valve replacement (AVR) in 8 patients (infranodal block 6 patients), tricuspid valve (TV) ring with mitral valve replacement or repair (MVR) in 10 patients (AV nodal block 9 patients), transcatheter aortic valve replacement (TAVR) in 4 patients (infranodal block 4 patients), and MVR alone in 6 patients. HBP was successful in 28 patients (93%) (selective HBP 50%). His bundle (HB) recruitment was unsuccessful in 2 patients with TAVR. AVR/TAVR and TV ring served as anatomic landmarks for localizing the HB. Successful sites of HBP were posterior and inferior to AVR/TAVR and distal and septal to the TV ring. Baseline QRSd improved from 124 ± 32 ms to 118 ± 20 ms (P = .39). HBP threshold at implant was 1.45 ± 1 V at 1 ms.ConclusionPermanent HBP was feasible in 93% of patients with PVs. Patients with AVR/TAVR predominantly developed infranodal block compared to AV nodal block in patients with TV ring/MVR. Location of PV might serve as a landmark for identifying the site of the HB.