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Troubleshooting and programming considerations for His bundle pacing

      Interest in permanent His bundle pacing as a means of both preventing pacing-induced cardiomyopathy and providing physiological resynchronization by normalization of His-Purkinje activation is steadily growing. However, there are differences in atrioventricular timing cycles, sensing, and tissue capture that distinguish His bundle pacing from right ventricular pacing, and hence it is of utmost importance to bear these differences in mind when implanting a His pacing lead and programming the His pacing system. This article focuses on critical considerations and troubleshooting options available to the implanter and follow-up clinic personnel.

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      References

        • Lustgarten D.L.
        • Calame S.
        • Crespo E.M.
        • Calame J.
        • Lobel R.
        • Spector P.S.
        Electrical resynchronization induced by direct His-bundle pacing.
        Heart Rhythm. 2010; 7: 15-21
        • Lustgarten D.L.
        • Crespo E.M.
        • Arkhipova-Jenkins I.
        • et al.
        His-bundle pacing versus biventricular pacing in cardiac resynchronization therapy patients: a crossover design comparison.
        Heart Rhythm. 2015; 12: 1548-1557
        • Teng A.E.
        • Lustgarten D.L.
        • Vijayaraman P.
        • et al.
        Usefulness of His bundle pacing to achieve electrical resynchronization in patients with complete left bundle branch block and the relation between native QRS axis, duration, and normalization.
        Am J Cardiol. 2016; 118: 527-534
        • Ajijola O.A.
        • Upadhyay G.A.
        • Macias C.
        • Shivkumar K.
        • Tung R.
        Permanent His-bundle pacing for cardiac resynchronization therapy: initial feasibility study in lieu of left ventricular lead.
        Heart Rhythm. 2017; 14: 1353-1361
        • Sharma P.S.
        • Naperkowski A.
        • Bauch T.D.
        • et al.
        Permanent His bundle pacing for cardiac resynchronization therapy in patients with heart failure and right bundle branch block.
        Circ Arrhythm Electrophysiol. 2018; 11: e006613
        • Deshmukh P.
        • Casavant D.A.
        • Romanyshyn M.
        • Anderson K.
        Permanent, direct His-bundle pacing: a novel approach to cardiac pacing in patients with normal His-Purkinje activation.
        Circulation. 2000; 101: 869-877
        • Kawashima T.
        • Sasaki H.
        A macroscopic anatomical investigation of atrioventricular bundle locational variation relative to the membranous part of the ventricular septum in elderly human hearts.
        Surg Radiol Anat. 2005; 27: 206-213
        • Vijayaraman P.
        • Dandamudi G.
        • Worsnick S.
        • Ellenbogen K.A.
        Acute His-bundle injury current during permanent His-bundle pacing predicts excellent pacing outcomes.
        Pacing Clin Electrophysiol. 2015; 38: 540-546
        • Vijayaraman P.
        • Ellenbogen K.A.
        Approach to permanent His bundle pacing in challenging implants.
        Heart Rhythm. 2018; 15: 1428-1431
        • Correa de Sa D.D.
        • Hardin N.J.
        • Crespo E.M.
        • Nicholas K.B.
        • Lustgarten D.L.
        Autopsy analysis of the implantation site of a permanent selective direct His bundle pacing lead.
        Circ Arrhythm Electrophysiol. 2012; 5: 244-246
        • Vijayaraman P.
        • Dandamudi G.
        • Zanon F.
        • et al.
        Permanent His bundle pacing: recommendations from a Multicenter His Bundle Pacing Collaborative Working Group for standardization of definitions, implant measurements, and follow-up.
        Heart Rhythm. 2018; 15: 460-468
        • Hirao K.
        • Otomo K.
        • Wang X.
        • et al.
        Para-Hisian pacing: a new method for differentiating retrograde conduction over an accessory AV pathway from conduction over the AV node.
        Circulation. 1996; 94: 1027-1035
        • Abdelrahman M.
        • Subzposh F.A.
        • Beer D.
        • et al.
        Clinical outcomes of His bundle pacing compared to right ventricular pacing.
        J Am Coll Cardiol. 2018; 71: 2319-2330
        • Auricchio A.
        • Ellenbogen K.A.
        Reducing ventricular pacing frequency in patients with atrioventricular block: is it time to change the current pacing paradigm?.
        Circ Arrhythm Electrophysiol. 2016; 9: 1-9
        • Vijayaraman P.
        • Naperkowski A.
        • Subzposh F.A.
        • et al.
        Permanent His-bundle pacing: long-term lead performance and clinical outcomes.
        Heart Rhythm. 2018; 15: 696-702