His bundle pacing’s considerations
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