Computerized tomography image correlation of His bundle/deep septal pacing location and outcomes: an analysis from the Canberra HIs bundle/deep septal Pacing Study (CHIPS)

Sreevilasam P. Abhilash, Deep Chandh Raja, Simon Stolcman, Dong Seok Yi, Moyazur Rahman, Ren Tan, Aakash Mahajan, Dennis H. Lau, Walter P. Abhayaratna, Prashanthan Sanders, Rajeev Kumar Pathak

Research output: Contribution to journalArticlepeer-review

5 Citations (Scopus)

Abstract

Background: Localisation of the conduction system under fluoroscopy is not easy and the ideal location of the pacing leads in physiological pacing is still being debated. Objective: The primary aim was to assess the lead locations using cardiac CT scan. Secondary aims were clinical outcomes including success and safety of the procedure and lead performance. Methods: Of the 100 consecutive patients who received physiological pacing, 34 patients underwent follow-up cardiac CT scan. The four different types of pacing were identified as His bundle (HBP), para-Hisian, left bundle branch (LBBP), and deep septal pacing. Results: Most patients had successful HBP via the right atrium (RA) (87.5%) as compared to the right ventricle (RV) (12.5%). Lower thresholds were observed when leads were placed within 2 mm of the junction of the membranous and muscular ventricular septum. Unlike HBP, LBBP was possible at a wide region of the septum and selective capture of individual fascicles was feasible. LBBP showed deeper penetration of leads into the septum, as compared to deep septal pacing (70% vs. 45%). Approximately, 80% of patients did not have an intra-ventricular portion of the membranous septum. Conclusions: The anterior part of the atrio-ventricular (AV) septum at the junction between the membranous and muscular septum via RA appeared to be the best target to successfully pace His bundle. LBBP was possible at a wide region of the septum and selective capture of individual fascicle was feasible. Adequate depth of penetration of lead was very important to capture the left bundle.

Original languageEnglish
Pages (from-to)137-148
Number of pages12
JournalJournal of Interventional Cardiac Electrophysiology
Volume64
Issue number1
DOIs
Publication statusPublished or Issued - Jun 2022

Keywords

  • Deep septal pacing
  • His bundle pacing (HBP)
  • Left bundle branch pacing (LBBP)
  • Para-Hisian pacing

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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