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(Circulation. 2000;101:836.)
© 2000 American Heart Association, Inc.

Editorials

Long-Term His-Bundle Pacing and Cardiac Function

Melvin M. Scheinman, MD; Leslie A. Saxon, MD

From the Department of Medicine, University of California, San Francisco.

Correspondence to Melvin M. Scheinman, MD, University of California, San Francisco, 500 Parnassus Ave, MU E Box 1354, San Francisco, CA 94143-1354. E-mail scheinman@ep4.ucsf.edu

Key Words: His bundle • pacing • heart failure • fibrillation

The article by Deshmukh et al¹ published elsewhere in the journal represents a tour de force for a number of reasons. The ability to chronically and selectively pace the His bundle not only represents an important methodological advance but also allows us to test the hypothesis that septal pacing in a fashion nearly identical to normal activation of the His-Purkinje system is superior to ventricular pacing.

This technical breakthrough deserves strong accolades. Those of us who have used His-bundle pacing either to validate His-bundle records² or for detection of concealed parahisian pathways³ will attest to the difficulty in achieving even temporary consistent His-bundle pacing. The authors have shown that placing a standard multipolar mapping catheter as a guide at the His bundle facilitates placement of a commercially available steroid-eluting long-term pacing lead, incorporating an exposed helix, to be embedded in the membranous septum on or near the His bundle. This technique is feasible and allows for long-term pacing with acceptable stimulation thresholds.

The study group included 14 patients with atrial fibrillation and severe dilated cardiomyopathy but with narrow QRS complexes in whom reliable His-bundle stimulation was possible. Twelve of the 14 underwent insertion of the long-term lead, but 10 required AV junctional ablation allowing for rate control and persistent His-bundle pacing. Over a mean follow-up of nearly 2 years, they found rather dramatic improvements in both hemodynamic function and New York Heart Association class. The limitations of right ventricular pacing in improving ventricular function have been well appreciated. Right ventricular . . . [Full Text of this Article]