Intermediate-term performance and safety of His-bundle pacing leads: A single-center experience

BACKGROUND The short-term safety, feasibility, and performance of His-bundle pacing (HBP) leads have been reported; however, their longer-term performance beyond 1 year remains unclear. OBJECTIVE The purpose of this study was to examine the intermediate-term performance and safety of HBP. METHODS All HBP lead implants at Virginia Commonwealth University between January 2014 and January 2019 were analyzed. HBP was performed using a Medtronic SelectSecure 3830-69 cm pacing lead. RESULTS Of 295 attempts, successful HBP implantation (selective or nonselective) was seen in 274 cases (93%). Mean follow-up duration was 22.8 +/- 19.5 months (median 19.5; interquartile range 11-33). Mean age was 69 +/- 15 years; 58% were males; and ejection fraction <50 0 /0 was noted in 30%. Indications for pacemaker included sick sinus syndrome in 41%, atrioventricular block in 36%, cardiac resynchronization therapy in 7%, and refractory atrial fibrillation in 15%. Selective HBP was achieved in 33%. Mean HBP capture threshold at implant was 1.1 +/- 0.9 V at 0.8 +/- 0.2 ms, which significantly increased at chronic follow-up to 1.7 +/- 1.1 V at 0.8 +/- 0.3 ms (P <.001). Threshold was >2.5 V in 24% of patients, and 28% had an increase in HBP threshold >1 V. Loss of His-bundle capture at follow-up (septal right ventricular pacing) was seen in 17%. There was a total of 31 (11%) lead revisions, primarily for unacceptably high thresholds. CONCLUSION Although HBP can prevent or improve pacing-induced cardiomyopathy, the elevated capture thresholds, loss of His-bundle capture, and lead revision rates at intermediate follow-up are of concern. Longer-term follow-up data from multiple centers are needed.

Automated summary

This study examined the intermediate-term performance and safety of His-bundle pacing leads, finding a high success rate of HBP implantation but an increase in capture threshold and loss of His-bundle capture in some patients during follow-up. Further data from multiple centers are needed for longer-term follow-up.