Electrophysiological Characteristics and Mechanism of His-Bundle Pacing Guided by Electrocardiograms in Uninterrupted Real-Time Monitoring Technique.

IF 1.7 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Pace-Pacing and Clinical Electrophysiology Pub Date : 2025-01-01 Epub Date: 2024-11-16 DOI:10.1111/pace.15106

Jinyan Zhong, Longfu Jiang, Yuelin Zhang, Nan Zheng, Hengdong Li

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引用次数: 0

Abstract

Background: His-bundle pacing (HBP) is a pacing mode that provides near-physiological pacing and has more advantages over standard right ventricle (RV) septum pacing in positive clinical results. However, traditional HBP cannot accurately and stably place the lead tip into the His-Purkinje system. Hence, this study aimed to establish a novel strategy for HBP to strike a balance between an excellent pacing threshold and minor injuries to the conduction system.

Methods: HBP, using continuous and real-time monitoring of unipolar His-bundle (HB) electrograms along with electrocardiograms, was performed in 29 consecutive atrial fibrillation patients. We analyzed the unipolar HB intracardiac electrogram (EGM) and electrophysiological characteristics during HBP using John Jiang's connecting cable and an electrophysiology recording system. All patients were followed up for 12 months.

Results: Of the 29 patients, 28 (96.55%) successfully received HBP. Twenty-one (75%) patients were confirmed to have the negative deflection of His potential with a negative amplitude of ≥ 0.1 mV in HB EGM. The subgroup with a deep negative deflection was recorded with an HBP threshold (0.71 ± 0.41 V), significantly lower than those thresholds with no deep negative deflection (1.83 ± 0.76 V) (p < 0.05). The selective HBP rate was significantly different between the two groups: 20 (95.24%) in the deep negative deflection group and three (42.86%) in the non-deep negative deflection group (p < 0.05); five (17.24%) patients presented right bundle branch block (RBBB) during the lead placement.

Conclusions: This study supports the safety and feasibility of using an uninterrupted real-time monitoring technique for HBP. An uninterrupted real-time monitoring technique can guide the accurate placement of the HB lead and may provide a balance between an excellent pacing threshold and minor injury to the conduction system.

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不间断实时监测技术中心电图引导 His-Bundle 起搏的电生理特点和机制

背景：His-束起搏（HBP）是一种能提供接近生理起搏的起搏模式，与标准的右心室（RV）隔膜起搏相比，HBP具有更多优势，能取得积极的临床效果。然而，传统的 HBP 无法准确、稳定地将导联尖端置入 His-Purkinje 系统。因此，本研究旨在建立一种新的 HBP 策略，以在出色的起搏阈值和对传导系统的轻微损伤之间取得平衡。方法：我们对 29 名连续心房颤动患者进行了 HBP，使用了单极 His-bundle (HB) 电图和心电图的连续实时监测。我们使用 John Jiang 的连接电缆和电生理记录系统分析了 HBP 期间的单极 HB 心内电图（EGM）和电生理特征。所有患者均接受了 12 个月的随访：29 名患者中，28 名（96.55%）成功接受了 HBP。21名患者（75%）被证实在 HB EGM 中出现 His 电位负偏转，负振幅≥ 0.1 mV。有深度负偏转的亚组记录到的 HBP 阈值（0.71 ± 0.41 V）明显低于无深度负偏转的阈值（1.83 ± 0.76 V）（P < 0.05）。两组患者的选择性 HBP 率有显著差异：深负偏转组 20 例（95.24%），非深负偏转组 3 例（42.86%）（P < 0.05）；5 例（17.24%）患者在导联置入过程中出现右束支传导阻滞（RBBB）：本研究证实了使用不间断实时监测技术治疗 HBP 的安全性和可行性。不间断实时监测技术可指导 HB 导联的准确置入，并可在良好的起搏阈值和对传导系统的轻微损伤之间取得平衡。

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来源期刊

Pace-Pacing and Clinical Electrophysiology 医学-工程：生物医学

CiteScore

2.70

自引率

5.60%

发文量

209

审稿时长

2-4 weeks

期刊介绍： Pacing and Clinical Electrophysiology (PACE) is the foremost peer-reviewed journal in the field of pacing and implantable cardioversion defibrillation, publishing over 50% of all English language articles in its field, featuring original, review, and didactic papers, and case reports related to daily practice. Articles also include editorials, book reviews, Musings on humane topics relevant to medical practice, electrophysiology (EP) rounds, device rounds, and information concerning the quality of devices used in the practice of the specialty.