Low Fluoroscopy Permanent His Bundle Pacing Using Electroanatomic Mapping: A Feasibility Study

Circ Arrhythm Electrophysiol. 2019 Feb;12(2):e006967. doi: 10.1161/CIRCEP.118.006967.


Background: Conventional permanent His Bundle pacing (PHBP) can be challenging and associated with high fluoroscopy exposure. The aim of this study was to assess the feasibility and safety of performing low fluoroscopy PHBP using 3-dimensional electroanatomic mapping and comparing outcomes with conventional fluoroscopy guided PHBP implants.

Methods: PHBP was performed at 2 centers using electroanatomic mapping-guided low fluoroscopy implantation in 10 patients using a novel protocol (group 1) and conventional fluoroscopy guided implantation in 20 patients (group 2). The primary end point was feasibility of achieving PHBP with low/zero fluoroscopy and safety end points included total radiation exposure (fluoroscopy time and dose area product), procedure-related complications associated with lead implantation or need for lead revisions.

Results: PHBP was successful in 9 of 10 patients (90%) in group 1 and 100% successful in the group 2 patients. The mean His lead fluoroscopy time was significantly lower in group 1 (0.2±0.2 minutes) compared with 8±7 minutes in group 2 ( P=0.002) as was the total fluoroscopy time (0.8±0.3 versus 13±8 minutes, P=0.003) and the dose area product (96±83 versus 1531±923 microGy/m2, P=0.003). The HB capture threshold was lower in group 1 (0.7±0.4 at 1 ms) compared with patients in group 2 (1.15±0.7 at 1 ms) P=0.04. There were no procedure-related complications or lead dislodgements in either group. There was an increase in HB capture threshold in 1 patient (5%) in group 2 at 1-month follow-up.

Conclusions: Electroanatomic mapping-guided PHBP is feasible can be performed safely and results in a significant reduction in fluoroscopy duration and exposure.

Keywords: His Bundle; His Bundle pacing; cardiac resynchronization therapy; electrophysiology; fluoroscopy; radiation exposure; safety.

Publication types

  • Comparative Study
  • Multicenter Study
  • Observational Study

MeSH terms

  • Action Potentials*
  • Aged
  • Aged, 80 and over
  • Arrhythmias, Cardiac / diagnosis
  • Arrhythmias, Cardiac / physiopathology
  • Arrhythmias, Cardiac / therapy*
  • Bundle of His / physiopathology*
  • Cardiac Pacing, Artificial / adverse effects
  • Cardiac Pacing, Artificial / methods*
  • Chicago
  • Electrophysiologic Techniques, Cardiac
  • Feasibility Studies
  • Female
  • Fluoroscopy
  • Heart Rate
  • Humans
  • Male
  • Middle Aged
  • Pennsylvania
  • Predictive Value of Tests
  • Prospective Studies
  • Radiation Dosage
  • Radiation Exposure / adverse effects
  • Radiation Exposure / prevention & control
  • Radiography, Interventional / adverse effects
  • Radiography, Interventional / methods*
  • Signal Processing, Computer-Assisted
  • Time Factors
  • Treatment Outcome