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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.1,2 Since the initial description of permanent His bundle pacing (HBP) by Deshmukh et al in 2000,3 several investigators have demonstrated the clinical utility of HBP in patients with atrioventricular (AV) nodal block, infranodal AV block, and bundle branch block.4–7 Increasing interest in HBP has been hampered in part by challenges and limitations associated with a limited implantation tool set.Prevention of phrenic nerve injury during interventional electrophysiologic procedures
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The advent of innovative, potent ablative technologies and the adoption of endo–epicardial approaches to treat various arrhythmias have engendered a need for developing strategies to prevent collateral damage to critical structures such as the phrenic nerve (PN) and the esophagus during percutaneous electrophysiologic interventions. Here we detail phrenic nerve injury (PNI) prevention strategies during atrial fibrillation (AF), atrial tachycardia (AT), and ventricular tachycardia (VT) ablation. PNI is more common on the right side because of the anatomic course of the nerve and the greater preponderance of AF and AT ablations.
