Selective His-bundle pacing in an adult with atrioventricular canal defect via retrograde His localization

Anastasia Bury, Daniel Cortez

Research output: Contribution to journalArticlepeer-review

Abstract

Adult congenital heart disease patients may undergo numerous fluoroscopically guided procedures including pacemaker implantation during their lifetime. One alternative to traditional pacemaker setup which may improve long-term pacing outcomes is His bundle pacing. Given the altered His-bundle location, and given increased radiation exposure over a lifetime, we used 3-dimensional mapping to locate the His and to minimize fluoroscopy for placement of a His-bundle pacemaker system in a 31-year old patient with atrioventricular canal defect and complete heart block with 100% RV pacing and epicardial lead fracture. Methods: An Octapolar Livewire catheter (Abbott, Minneapolis, USA) was used for mapping and location of the His bundle from a right femoral venous access on the EnSite Precision system 3-dimensional mapping system (Abbott Medical, Abbott Park, IL). The same map was used to guide 3830 lead placement into the posterior-inferior His-bundle position. Results: Successful placement of a His-bundle pacing system with thresholds of 1Volt@0.4ms for both the atrial and ventricular leads with selective His-bundle pacing noted. Ten-month follow-up demonstrated His-bundle capture at 0.75V@0.4ms with stable impedance, sensing and with 100% right ventricular pacing a projected longevity of 12 years total. Conclusions: Successful placement of selective His-bundle pacing can be achieved in an adult patient with atrioventricular canal defect using 3-dimensional mapping.

Original languageEnglish (US)
Pages (from-to)313-315
Number of pages3
JournalIndian Pacing and Electrophysiology Journal
Volume21
Issue number5
Early online dateJun 2 2021
DOIs
StatePublished - Sep 1 2021
Externally publishedYes

Bibliographical note

Publisher Copyright:
© 2021 Indian Heart Rhythm Society

Keywords

  • 3-Dimensional mapping
  • Atrioventricular canal defect
  • His-bundle pacing

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