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Approach to permanent His bundle pacing in challenging implants

      Right ventricular apical pacing has been the cornerstone of bradycardia pacing for decades. It is well established that right ventricular pacing leads to ventricular dyssynchrony, reduced left ventricular function, and heart failure.
      • Tse H.F.
      • Lau C.P.
      Long-term effect of right ventricular pacing on myocardial perfusion and function.
      • Sweeney M.O.
      • Hellkamp A.S.
      • Ellenbogen K.A.
      • Greenspon A.J.
      • Freedman R.A.
      • Lee K.L.
      • Lamas G.A.
      MOde Selection Trial Investigators
      Adverse effect of ventricular pacing on heart failure and atrial fibrillation among patients with normal baseline QRS duration in a clinical trial of pacemaker therapy for sinus node dysfunction.
      Since the initial description of permanent His bundle pacing (HBP) by Deshmukh et al in 2000,
      • Deshmukh P.
      • Casavant D.
      • Romanyshyn M.
      • Anderson K.
      Permanent direct His bundle pacing: a novel approach to cardiac pacing in patients with normal His-Purkinje activation.
      several investigators have demonstrated the clinical utility of HBP in patients with atrioventricular (AV) nodal block, infranodal AV block, and bundle branch block.
      • Zanon F.
      • Svetlich C.
      • Occhetta E.
      • Catanzariti D.
      • Cantù F.
      • Padeletti L.
      • Santini M.
      • Senatore G.
      • Comisso J.
      • Varbaro A.
      • Denaro A.
      • Sagone A.
      Safety and performance of a system specifically designed for selective site pacing.
      • Sharma P.
      • Dandamudi G.
      • Naperkowski A.
      • Oren J.W.
      • Storm R.H.
      • Ellenbogen K.A.
      • Vijayaraman P.
      Permanent His bundle pacing is feasible, safe and superior to right ventricular pacing in routine clinical practice.
      • Vijayaraman P.
      • Naperkowski A.
      • Ellenbogen K.A.
      • Dandamudi G.
      Electrophysiologic insights into site of atrioventricular block: lessons from permanent His bundle pacing.
      • Lustgarten D.L.
      • Crespo E.M.
      • Arkhipova-Jenkins I.
      • Lobel R.
      • Winget J.
      • Koehler J.
      • Liberman E.
      • Sheldon T.
      His-bundle pacing versus biventricular pacing in cardiac resynchronization therapy patients: a crossover design comparison.
      Increasing interest in HBP has been hampered in part by challenges and limitations associated with a limited implantation tool set. We have previously described our technique for routine permanent HBP.
      • Dandamudi G.
      • Vijayaraman P.
      How to perform permanent His bundle pacing in routine clinical practice.
      In this article we discuss a few modifications of our implantation technique to overcome some of the challenges in HBP.

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      References

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        • Lee K.L.
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        Adverse effect of ventricular pacing on heart failure and atrial fibrillation among patients with normal baseline QRS duration in a clinical trial of pacemaker therapy for sinus node dysfunction.
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        Safety and performance of a system specifically designed for selective site pacing.
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        Permanent His bundle pacing is feasible, safe and superior to right ventricular pacing in routine clinical practice.
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