Bundle of His – ABC CARDIOL

ABCHF

Review Article

Conduction System Pacing: Redefining Resynchronization Therapy in Heart Failure

Caique M. P. Ternes et al. André Zimerman

Abstract

Cardiac resynchronization therapy is a foundational treatment in patients with heart failure with reduced ejection fraction (HFrEF) and left bundle branch block (LBBB). Although resynchronization has traditionally been performed via biventricular pacing, this approach may be limited by a high rate of non-responders and elevated cost. Conduction system pacing, sometimes referred to as “physiologic” pacing, involves direct stimulation of the heart’s intrinsic conduction pathways and has emerged as a promising alternative. Large intercontinental registries have supported the safety of conduction system pacing in different settings, with high procedural success and low complication rates that are comparable to biventricular pacing. Moreover, in small, randomized trials, conduction system pacing has led to similar or greater improvements in left ventricular ejection fraction and QRS duration versus biventricular pacing, potentially at a lower cost. Ongoing cardiovascular outcomes trials are expected to conclusively determine the role of conduction system pacing in the management of patients with HFrEF and LBBB.

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ABC

Original Article

Catheter Ablation of Focal Atrial Tachycardia with Early Activation Close to the His-Bundle from the Non Coronary Aortic Cusp

Muhieddine Chokr et al. Lucas G. de Moura Italo Bruno dos Santos Sousa Cristiano Faria Pisani … Carina Abigail Hardy Sissy Lara de Melo Arnobio Dias da Ponte Filho Ieda Prata Costa Ronaldo Vasconcelos Tavora Luciana Sacilotto Tan Chen Wu Francisco Carlos da Costa Darrieux Denise Tessariol Hachul Vera Demarchi Aiello Mauricio Scanavacca

Abstract

Background

Atrial tachycardia (AT) ablation with earliest activation site close to the His-Bundle is a challenge due to the risk of complete AV block by its proximity to His-Purkinje system (HPS). An alternative to minimize this risk is to position the catheter on the non-coronary cusp (NCC), which is anatomically contiguous to the para-Hisian region.

Objectives

The aim of this study was to perform a literature review and evaluate the electrophysiological characteristics, safety, and success rate of catheter-based radiofrequency (RF) delivery in the NCC for the treatment of para-Hisian AT in a case series.

Methods

This study performed a retrospective evaluation of ten patients (Age: 36±10 y-o) who had been referred for SVT ablation and presented a diagnosis of para-Hisian focal AT confirmed by classical electrophysiological maneuvers. For statistical analysis, a p-value of <0.05 was considered statistically significant.

Results

The earliest atrial activation at the His position was 28±12ms from the P wave and at the NCC was 3±2ms earlier than His position, without evidence of His potential in all patients. RF was applied on the NCC (4-mm-tip catheter; 30W, 55ºC), and the tachycardia was interrupted in 5±3s with no increase in the PR interval or evidence of junctional rhythm. Electrophysiological tests did not reinduce tachycardia in 9/10 of patients. There were no complications in all procedures. During the 30 ± 12 months follow-up, no patient presented tachycardia recurrence.

Conclusion

The percutaneous treatment of para-Hisian AT through the NCC is an effective and safe strategy, which represents an interesting option for the treatment of this complex arrhythmia. (Arq Bras Cardiol. 2021; 116(1):119-126)

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Conduction System Pacing: Redefining Resynchronization Therapy in Heart Failure

Abstract

Catheter Ablation of Focal Atrial Tachycardia with Early Activation Close to the His-Bundle from the Non Coronary Aortic Cusp

Abstract

Background

Objectives

Methods

Results

Conclusion

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Electronic Document Format (Vancouver)

Electronic Document Format (ABNT)

Electronic Document Format (APA)

Electronic Document Format (ISO)