Hands On
A beginner's guide to permanent left bundle branch pacing
Studies have demonstrated the feasibility and clinical benefits of permanent His-bundle pacing (HBP).1 However, concerns regarding higher pacing thresholds, lower R-wave amplitudes, and the potential to develop distal conduction block have limited the clinical application of HBP in certain subgroups.1,2Approach 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.How to perform permanent His bundle pacing in routine clinical practice
Over the years, various sites of ventricular pacing have been evaluated in clinical trials. Earlier trials established the detrimental effects of right ventricular (RV) apical pacing, including increased risk of atrial fibrillation, heart failure (HF), and mortality. Alternate RV pacing sites have yielded mixed results.1 Biventricular (BiV) pacing in advanced HF and electrical dyssynchrony reduced HF hospitalizations and mortality. Recently, 2 trials evaluated the clinical utility of BiV pacing in the setting of heart block and demonstrated equivocal results.
