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Case Reports
. 2022 Apr 16;26(2):126-129.
doi: 10.1016/j.jccase.2022.03.015. eCollection 2022 Aug.

Closed loop stimulation with His bundle lead placement

Leonardo Marinaccio  1 , Daniele Giacopelli  2   3 , Giuliana Ginocchio  1 , Francesco Vetta  4 , Domenico Marchese  1
Affiliations
Case Reports

Closed loop stimulation with His bundle lead placement

Leonardo Marinaccio et al. J Cardiol Cases. .

Abstract

Closed-loop stimulation (CLS; BIOTRONIK SE & Co. KG, Berlin, Germany) is a rate-responsive algorithm that analyzes intracardiac impedance trends using a standard lead placed in the right ventricle. It is unknown whether CLS could perform adequately with His bundle (HB) lead placement, as contractility dynamics may be attenuated in this region compared to the right ventricle apex.We performed hand-grip, mental, and bicycle exercise tests in a patient with brady atrial fibrillation and permanent HB pacing. The CLS algorithm responded with an appropriate heart rate to mental and physical tests.

Learning objective: A combination of permanent His bundle and closed-loop stimulation-driven pacing may be a valid and physiological option for atrial fibrillation patients with chronotropic incompetence.

Keywords: AF, Atrial fibrillation; CLS, Closed loop stimulation; Chronotropic incompetence; Closed loop stimulation; DBP, Diastolic blood pressure; HBP, His bundle pacing; HR, Heart rate; His bundle pacing; RV, Right ventricle; Rate modulation; SBP, Systolic blood pressure; Sensor.

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Conflict of interest statement

D. G. is an employee of Biotronik Italia, the remaining authors have no conflicts of interest to disclose.

Figures

Fig. 1
Fig. 1
(A) Left anterior oblique X-ray projection showing the lead during His area mapping before screwing. (B) Surface 12‑lead ECG (green) and intracardiac EGM (yellow) at the final lead position (printing speed: 50 mm per second); note the His signal (white arrow) on intracardiac EGM during spontaneous rhythm and the non-selective His bundle capture with pacing spike (yellow arrow) and pseudo-delta wave (red arrow). ECG, electrocardiogram; EGM, electrograms; HBP, His bundle pacing.
Fig. 2
Fig. 2
(A) The permanent His bundle pacing was achieved using a stylet-driven lead delivered in the Hisian area and connected to a single-chamber pacemaker. (B) Surface 12‑lead electrocardiogram (ECG) (printing speed: 25 mm per second) at the exercise stress test start showing pacing rhythm induced by closed-loop stimulation (CLS). (C) Surface 12‑lead ECG at maximum workload of the exercise stress test showing pacing rhythm induced by CLS at 120 bpm.
Fig. 3
Fig. 3
(A) Histogram of heart rate sensed (Vs) and paced (Vp) ventricular events with VVI-CLS 60–120 bpm pacing mode 2 months after the implant. Trends of heart rate, systolic and diastolic blood pressure (BP) during hand-grip (B), Stroop Color Word (C), and bicycle exercise (D) tests.
See this image and copyright information in PMC

References

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