Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2020 Apr;31(4):813-821.
doi: 10.1111/jce.14371. Epub 2020 Feb 5.

Feasibility of His-bundle pacing in patients with conduction disorders following transcatheter aortic valve replacement

Jan De Pooter  1 , Anaïs Gauthey  2 , Simon Calle  1 , Antoine Noel  3 , Joelle Kefer  2 , Sebastien Marchandise  2 , Mathieu Coeman  1 , Tine Philipsen  4 , Peter Kayaert, Peter Gheeraert  1 , Luc Jordaens  1 , Frank Timmermans  1 , Frederic Van Heuverswyn  1 , Pierre Bordachar  3 , Jean-Benoît le Polain de Waroux  2
Affiliations
Multicenter Study

Feasibility of His-bundle pacing in patients with conduction disorders following transcatheter aortic valve replacement

Jan De Pooter et al. J Cardiovasc Electrophysiol. 2020 Apr.

Abstract

Background: Conduction disorders requiring permanent pacemaker implantation occur frequently after transcatheter aortic valve replacement (TAVR). This multicenter study explored the feasibility and safety of His bundle pacing (HBP) in TAVR patients with a pacemaker indication to correct a TAVR-induced left bundle branch block (LBBB).

Methods: Patients qualifying for a permanent pacemaker implant after TAVR were planned for HBP implant. HBP was performed using the Select Secure (3830; Medtronic) pacing lead, delivered through a fixed curve or deflectable sheath (C315HIS or C304; Medtronic). Successful HBP was defined as selective or nonselective HBP, irrespective of LBB recruitment. Successful LBBB correction was defined as selective or nonselective HBP resulting in paced QRS morphology similar to pre-TAVR QRS and paced QRS duration (QRSd) less than 120 milliseconds with thresholds less than 3.0 V at 1.0-millisecond pulse width.

Results: The study enrolled 16 patients requiring a permanent pacemaker after TAVR (age 85 ± 4 years, 31% female, all LBBB; QRSd: 161 ± 14 milliseconds). Capture of the His bundle was achieved in 13 of 16 (81%) patients. HBP with LBBB correction was achieved in 11 of 16 (69%) and QRSd narrowed from 162 ± 14 to 99 ± 13 milliseconds and 134 ± 7 milliseconds during S-HBP and NS-HBP, respectively (P = .005). At implantation, mean threshold for LBBB correction was 1.9 ± 1.1 V at 1.0 millisecond. Thresholds remained stable at 11 ± 4 months follow-up (1.8 ± 0.9 V at 1.0 millisecond, P = .231 for comparison with implant thresholds). During HBP implant, one temporary complete atrioventricular block occurred.

Conclusion: Permanent HBP is feasible in the majority of patients with TAVR requiring a permanent pacemaker with the potential to correct a TAVR-induced LBBB with acceptable pacing thresholds.

Keywords: His bundle pacing; TAVR; complication; conduction disturbance; left bundle branch block.

PubMed Disclaimer

Comment in

  • The search for physiologic pacing post-TAVR.
    Cano Ó, Vijayaraman P. Cano Ó, et al. J Cardiovasc Electrophysiol. 2020 Apr;31(4):822-824. doi: 10.1111/jce.14372. Epub 2020 Feb 6. J Cardiovasc Electrophysiol. 2020. PMID: 31990115 No abstract available.

References

REFERENCES

    1. Leon MB, Smith CR, Mack MJ, et al. Transcatheter or surgical aortic-valve replacement in intermediate-risk patients. N Engl J Med. 2016;374(17):1609-1620.
    1. Thyregod HGH, Ihlemann N, Jorgensen TH, et al. Five-year clinical and echocardiographic outcomes from the Nordic Aortic Valve Intervention (NOTION) randomized clinical trial in lower surgical risk patients. Circulation. 2019;139:2714-2723.
    1. Mack MJ, Leon MB, Smith CR, et al. 5-year outcomes of transcatheter aortic valve replacement or surgical aortic valve replacement for high surgical risk patients with aortic stenosis (PARTNER 1): a randomised controlled trial. Lancet. 2015;385(9986):2477-2484.
    1. Popma JJ, Deeb GM, Yakubov SJ, et al. Transcatheter aortic-valve replacement with a self-expanding valve in low-risk patients. N Engl J Med. 2019;380(18):1706-1715.
    1. Mack MJ, Leon MB, Thourani VH, et al. Transcatheter aortic-valve replacement with a balloon-expandable valve in low-risk patients. N Engl J Med. 2019;380(18):1695-1705.

Publication types

LinkOut - more resources