His bundle pacing, learning curve, procedure characteristics, safety and feasibility: insights from a large international observational study.

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Title: His bundle pacing, learning curve, procedure characteristics, safety and feasibility: insights from a large international observational study.
Authors: Keene, D
Whinnett, Z
Francis, D
Shun-Shin, M
Arnold, A
Item Type: Journal Article
Abstract: Background His‐bundle pacing (HBP) provides physiological ventricular activation. Observational studies have demonstrated the techniques feasibility however, data has come from a limited number of centres. Objectives We set out to explore contemporary global practise in HBP focusing on learning curve, procedural characteristics and outcomes. Methods This is a retrospective, multi‐centre observational study of patients undergoing attempted HBP at seven centres. Pacing indication, fluoroscopy time, HBP thresholds and lead re‐intervention and deactivation rates were recorded. Where centres had systematically recorded implant success rates from the outset, these were collated. Results 529 patients underwent attempted HBP during the study period (2014‐19) with mean follow‐up of 217±303 days. Most implants were for bradycardia indications. In the three centres with systematic collation of all attempts, overall implant success rate was 81% which improved to 87% after completion of 40 cases. All seven centres reported data on successful implants. Mean fluoroscopy time was 11.7±12.0 minutes, His‐bundle capture threshold at implant was 1.4±0.9V at 0.8±0.3 ms and was 1.3±1.2V at 0.9±0.2ms at last device check. HBP lead re‐intervention or deactivation (for lead displacement or rise in threshold) occurred in 7.5% of successful implants. There was evidence of a learning curve: fluoroscopy time and HBP capture threshold reduced with greater experience, plateauing after ~30‐50 cases. Conclusion We found that it is feasible to establish a successful HBP program, using the currently available implantation tools. For physicians who are experienced at pacemaker implantation the steepest part of the learning curve appears to be over the first 30‐50 cases.
Issue Date: 16-Jul-2019
Date of Acceptance: 7-Jul-2019
URI: http://hdl.handle.net/10044/1/71876
DOI: https://doi.org/10.1111/jce.14064
ISSN: 1045-3873
Publisher: Wiley
Journal / Book Title: Journal of Cardiovascular Electrophysiology
Copyright Statement: © 1999-2019 John Wiley & Sons, Inc. All rights reserved. This is the peer reviewed version of the following article: Keene, D. , Arnold, A. D., Jastrzębski, M. , Burri, H. , Zweibel, S. , Crespo, E. , Chandrasekaran, B. , Bassi, S. , Joghetaei, N. , Swift, M. , Moskal, P. , Francis, D. P., Foley, P. , Shun‐Shin, M. J. and Whinnett, Z. I. (2019), His bundle pacing, learning curve, procedure characteristics, safety and feasibility: insights from a large international observational study. J Cardiovasc Electrophysiol. Accepted Author Manuscript. , which has been published in final form at https://doi.org/10.1111/jce.14064. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions.
Sponsor/Funder: British Heart Foundation
British Heart Foundation
British Heart Foundation
Funder's Grant Number: FS/13/44/30291
CS/15/3/31405
FS/15/53/31615
Keywords: Cardiovascular System & Hematology
1102 Cardiorespiratory Medicine and Haematology
Publication Status: Published online
Embargo Date: 2020-07-16
Online Publication Date: 2019-07-16
Appears in Collections:National Heart and Lung Institute



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