Purpose

The implantation site of the His bundle (HB) lead may influence pacing parameters. Our aim was to characterize the anatomical location of the HB lead tip and its relationship with acute electrical parameters.

Methods

Consecutive patients who underwent HB lead implantation, guided by standard fluoroscopy and electrophysiology, were prospectively enrolled. The relationship between HB lead tip and tricuspid valve plane (TVP) was assessed with post-procedure transthoracic echocardiography.

Results

Twenty-five patients were studied. In 11 patients (44%), the HB lead tip did not cross the TVP (A group): in 7 cases it was screwed in the right atrium at a mean distance of −6.1 mm from the TVP and, in 4 cases, at the level of the tricuspid annulus. In the remaining 14 patients (56%), the lead tip crossed the TVP (V group): it was screwed in the right ventricle at a mean distance of 9.3 mm from the TVP. A and V groups had comparable HB capture thresholds (1.6 ± 1 V vs 1.7 ± 0.7 V, 1 ms pulse-width; p = 0.66); selective HB capture was significantly more represented in the A group (91% vs 21%; p = 0.001). Significantly higher R-wave amplitudes were seen in the V group (6.7 ± 3 vs 2.5 ± 1.7 mV; p = 0.0004), and they positively correlated with the distance from the TVP (p = 0.0038). Atrial oversensing was never observed.

Conclusion

In a consecutive cohort of HB pacing recipients, the rate of patients who had an effective HB capture in the atrium was substantial and was characterized by different electrophysiological properties than in the ventricle.

中文翻译：

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希氏束起搏中解剖结构与电参数的关系：经胸超声心动图评估

目的

希氏束 (HB) 导线的植入部位可能会影响起搏参数。我们的目标是表征 HB 引线尖端的解剖位置及其与急性电参数的关系。

方法

前瞻性纳入在标准透视和电生理学指导下接受 HB 导线植入的连续患者。通过术后经胸超声心动图评估 HB 导线尖端和三尖瓣平面 (TVP) 之间的关系。

结果

研究了 25 名患者。在 11 名患者 (44%) 中，HB 导联尖端未穿过 TVP（A 组）：7 名患者将其拧入右心房，距 TVP 平均距离为 -6.1 mm，4 名患者在三尖瓣环的水平。在其余 14 名患者 (56%) 中，导线尖端穿过 TVP（V 组）：它被拧入右心室，距离 TVP 的平均距离为 9.3 mm。A 组和 V 组具有相当的 HB 捕获阈值（1.6 ± 1 V vs 1.7 ± 0.7 V，1 ms 脉冲宽度；p = 0.66）；选择性 HB 捕获在 A 组中明显更多（91% 对 21%；p = 0.001）。在 V 组中观察到显着更高的 R 波幅度（6.7 ± 3 对 2.5 ± 1.7 mV；p= 0.0004），并且它们与与 TVP 的距离呈正相关（p = 0.0038）。从未观察到心房过度感知。

结论

在连续的 HB 起搏接受者队列中，在心房中有效 HB 捕获的患者比例很高，并且具有与心室不同的电生理特性。