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Feasibility of His‐Bundle Pacing in patients with conduction disorders following Transcatheter Aortic Valve Replacement

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Abstract
Background Conduction disorders requiring permanent pacemaker implantation occur frequently after transcatheter aortic valve replacement (TAVR). This multicenter study explored the feasibility and safety of His bundle pacing (HBP) in TAVR patients with a pacemaker indication to correct a TAVR‐induced left bundle branch block (LBBB). Methods Patients qualifying for a permanent pacemaker implant after TAVR were planned for HBP implant. HBP was performed using the Select Secure (3830; Medtronic) pacing lead, delivered through a fixed curve or deflectable sheath (C315HIS or C304; Medtronic). Successful HBP was defined as selective or nonselective HBP, irrespective of LBB recruitment. Successful LBBB correction was defined as selective or nonselective HBP resulting in paced QRS morphology similar to pre‐TAVR QRS and paced QRS duration (QRSd) less than 120 milliseconds with thresholds less than 3.0 V at 1.0‐millisecond pulse width. Results The study enrolled 16 patients requiring a permanent pacemaker after TAVR (age 85 ± 4 years, 31% female, all LBBB; QRSd: 161 ± 14 milliseconds). Capture of the His bundle was achieved in 13 of 16 (81%) patients. HBP with LBBB correction was achieved in 11 of 16 (69%) and QRSd narrowed from 162 ± 14 to 99 ± 13 milliseconds and 134 ± 7 milliseconds during S‐HBP and NS‐HBP, respectively (P = .005). At implantation, mean threshold for LBBB correction was 1.9 ± 1.1 V at 1.0 millisecond. Thresholds remained stable at 11 ± 4 months follow‐up (1.8 ± 0.9 V at 1.0 millisecond, P = .231 for comparison with implant thresholds). During HBP implant, one temporary complete atrioventricular block occurred. Conclusion Permanent HBP is feasible in the majority of patients with TAVR requiring a permanent pacemaker with the potential to correct a TAVR‐induced LBBB with acceptable pacing thresholds.
Keywords
Physiology (medical), Cardiology and Cardiovascular Medicine

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MLA
De Pooter, Jan, et al. “Feasibility of His‐Bundle Pacing in Patients with Conduction Disorders Following Transcatheter Aortic Valve Replacement.” Journal of Cardiovascular Electrophysiology, Wiley, 2020.
APA
De Pooter, J., Gauthey, A., Calle, S., Noel, A., Kefer, J., Marchandise, S., … le Polain de Waroux, J. (2020). Feasibility of His‐Bundle Pacing in patients with conduction disorders following Transcatheter Aortic Valve Replacement. Journal of Cardiovascular Electrophysiology.
Chicago author-date
De Pooter, Jan, Anaïs Gauthey, Simon Calle, Antoine Noel, Joelle Kefer, Sebastien Marchandise, Mathieu Coeman, et al. 2020. “Feasibility of His‐Bundle Pacing in Patients with Conduction Disorders Following Transcatheter Aortic Valve Replacement.” Journal of Cardiovascular Electrophysiology.
Chicago author-date (all authors)
De Pooter, Jan, Anaïs Gauthey, Simon Calle, Antoine Noel, Joelle Kefer, Sebastien Marchandise, Mathieu Coeman, Tine Philipsen, Peter Kayaert, Peter Gheeraert, Luc Jordaens, Frank Timmermans, Frederic Van Heuverswyn, Pierre Bordachar, and Jean‐Benoît le Polain de Waroux. 2020. “Feasibility of His‐Bundle Pacing in Patients with Conduction Disorders Following Transcatheter Aortic Valve Replacement.” Journal of Cardiovascular Electrophysiology.
Vancouver
1.
De Pooter J, Gauthey A, Calle S, Noel A, Kefer J, Marchandise S, et al. Feasibility of His‐Bundle Pacing in patients with conduction disorders following Transcatheter Aortic Valve Replacement. Journal of Cardiovascular Electrophysiology. 2020;
IEEE
[1]
J. De Pooter et al., “Feasibility of His‐Bundle Pacing in patients with conduction disorders following Transcatheter Aortic Valve Replacement,” Journal of Cardiovascular Electrophysiology, 2020.
@article{8645771,
  abstract     = {Background

Conduction disorders requiring permanent pacemaker implantation occur frequently after transcatheter aortic valve replacement (TAVR). This multicenter study explored the feasibility and safety of His bundle pacing (HBP) in TAVR patients with a pacemaker indication to correct a TAVR‐induced left bundle branch block (LBBB).
Methods

Patients qualifying for a permanent pacemaker implant after TAVR were planned for HBP implant. HBP was performed using the Select Secure (3830; Medtronic) pacing lead, delivered through a fixed curve or deflectable sheath (C315HIS or C304; Medtronic).

Successful HBP was defined as selective or nonselective HBP, irrespective of LBB recruitment. Successful LBBB correction was defined as selective or nonselective HBP resulting in paced QRS morphology similar to pre‐TAVR QRS and paced QRS duration (QRSd) less than 120 milliseconds with thresholds less than 3.0 V at 1.0‐millisecond pulse width.
Results

The study enrolled 16 patients requiring a permanent pacemaker after TAVR (age 85 ± 4 years, 31% female, all LBBB; QRSd: 161 ± 14 milliseconds). Capture of the His bundle was achieved in 13 of 16 (81%) patients. HBP with LBBB correction was achieved in 11 of 16 (69%) and QRSd narrowed from 162 ± 14 to 99 ± 13 milliseconds and 134 ± 7 milliseconds during S‐HBP and NS‐HBP, respectively (P = .005). At implantation, mean threshold for LBBB correction was 1.9 ± 1.1 V at 1.0 millisecond. Thresholds remained stable at 11 ± 4 months follow‐up (1.8 ± 0.9 V at 1.0 millisecond, P = .231 for comparison with implant thresholds). During HBP implant, one temporary complete atrioventricular block occurred.
Conclusion

Permanent HBP is feasible in the majority of patients with TAVR requiring a permanent pacemaker with the potential to correct a TAVR‐induced LBBB with acceptable pacing thresholds.},
  author       = {De Pooter, Jan and Gauthey, Anaïs and Calle, Simon and Noel, Antoine and Kefer, Joelle and Marchandise, Sebastien and Coeman, Mathieu and Philipsen, Tine and Kayaert, Peter and Gheeraert, Peter and Jordaens, Luc and Timmermans, Frank and Van Heuverswyn, Frederic and Bordachar, Pierre and le Polain de Waroux, Jean‐Benoît},
  issn         = {1045-3873},
  journal      = {Journal of Cardiovascular Electrophysiology},
  keywords     = {Physiology (medical),Cardiology and Cardiovascular Medicine},
  language     = {eng},
  publisher    = {Wiley},
  title        = {Feasibility of His‐Bundle Pacing in patients with conduction disorders following Transcatheter Aortic Valve Replacement},
  url          = {http://dx.doi.org/10.1111/jce.14371},
  year         = {2020},
}

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