Anatomical |
complex formation and anatomical location of AV conduction system
minuscule dimensions
His bundle association within the myocardium
- under the membranous portion of IVS
- within the muscular portion of IVS - beneath the endocardium |
Technical |
Procedure related:
- fluoroscopy for localizing lead positions
- implantation tools - HBP lead (stylet, non-stylet driven) - His delivery sheath (deflectable, non-deflectable) Parameters related: - increase in pacing threshold - lead stability – dislodgement |
Programming |
Selective pacing
Non-Selective pacing
Myocardium-only pacing
Selective HBP
Non-Selective HBP
Myocardium-Only (Para-hisian) Pacing
Selective Left Bundle Branch Pacing
Non-Selective LBBP
Left Ventricular Septal Pacing
Right Ventricular Septal Pacing
Mid-septal capture
Anodal capture
variety of ECG responses during threshold checks requires extra
person, except implanter, during the procedure
correction or not of BBB
troubleshooting issues (during procedure & at outpatient follow-up)
- atrial oversensing
- ventricular undersensing - pacing artifacts which port the His lead is placed in (especially at CRT) specialized Pacemaker Technician is required closer surveillance is suggested every six months |