Use of Only a Regular Diagnostic His-Bundle Catheter for Both Fast and Reproducible “Para-Hisian Pacing” and Stable Right Ventricular Pacing

Authors

  • HEIN HEIDBÜCHEL M.D., Ph.D.,

    Corresponding author
    1. Department of Cardiology, University Hospital Gasthuisberg, University of Leuven, Leuven, Belgium
      Hein Heidbüchel, M.D., Ph.D., Department of Cardiology, University Hospital Gasthuisberg, Herestraat 49, B-3000 Leuven, Belgium, Fax: 32-16-34 42 40; E-mail: Hein.Heidbuchel@uz.kuleuven.ac.be
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  • HUGO ECTOR M.D., Ph.D.,

    1. Department of Cardiology, University Hospital Gasthuisberg, University of Leuven, Leuven, Belgium
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  • JEF ADAMS M.S.,

    1. Department of Cardiology, University Hospital Gasthuisberg, University of Leuven, Leuven, Belgium
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  • FRANS VAN DE WERF M.D., Ph.D.

    1. Department of Cardiology, University Hospital Gasthuisberg, University of Leuven, Leuven, Belgium
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  • Supported by a grant from the Fund for Scientific Research-Flanders(Belgium).

  • Presented in part at the the 18th Congress of the European Society of Cardiology, Birmingham, United Kingdom, August 1996.

Hein Heidbüchel, M.D., Ph.D., Department of Cardiology, University Hospital Gasthuisberg, Herestraat 49, B-3000 Leuven, Belgium, Fax: 32-16-34 42 40; E-mail: Hein.Heidbuchel@uz.kuleuven.ac.be

Abstract

Pacing from the Diagnostic His-Bundle Catheter. Introduction: Para-Hisian pacing, i.e., pacing the anteroseptal right ventricle (RV) with or without direct capture of the His bundle (HB), allows the differentiation of VA conduction over the AV node from conduction over an accessory pathway. Classically, it is performed by maneuvering a separate pacing catheter around the HB catheter, which may be difficult and time-consuming.

Methods and Results: This study prospectively evaluated the use of a single standard octapolar HB catheter with 2-mm interelectrode spacing for simultaneous (para-Hisian) pacing from the distal bipole and recording from the three proximal bipoles in 148 consecutive patients. Para-Hisian pacing was successful in 146 of 148 patients, performed within a median of only 10 seconds, and easily repeated several times during the course of an electrophysiologic study. Retrograde HB activation could he recorded in 132 of 146 patients; a clearly different surface ECG configuration confirmed the presence or absence of HB capture in all other patients. Interestingly, stable RV pacing could he performed from the HB catheter for the rest of the electrophysiologic study in 138 of 142 patients in whom this was tried. RV pacing from this site also led to better interpretation of retrograde conduction, due to clear visualization of retrograde HB activation.

Conclusion: Pacing from the distal dipole of a regular diagnostic HB catheter provides a fast and reliable way to perform para-Hisian pacing. Therefore, it may be advocated as a routine diagnostic protocol during electrophysiologic procedures. Moreover, pacing from this site obviates the need for a separate RV pacing catheter in most patients.

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