96-35: Long term follow-up of the hisian pacing: a single centre experience

Introduction: Long-term His bundle pacing aims at preventing the detrimental hemodynamic consequences of right ventricular (RV) apical stimulation but long-term results are limited. Methods: We analyzed 322 patients (age 75 ± 8 years; 60% males; 48% IIor III degrees AV block, 25% sinus node disease, 27% atrialfibrillation with slow ventricular rate) who received an Hisian (57.4%) or paraHisian lead (3830 Medtronic) from April 2004 to July2011. The mean basal left ventricular ejection fraction (LVEF) was 54 ± 12%. The Hisian lead was connected to the ventricular port of aCRT-P device in 149 (46.2%) patients, to the atrial or ventricular ports of a DR PM in 157 (48.7%) patients, or to the single entry of an SR device in 16 (4.9%) patients. A back up lead was inserted in RV apex or septum in 194 (60.2%) patients. Results: The mean length of follow up was 6.70 ± 2.34 years (median 6.90years). Mean LVEF at follow-up was 55.5 ± 12.3%. At the last ambulatory interrogation 237 (73.9%) patients showed ventricular pacing ≥90%. The mean longevity of the first implanted devices was 5.32 ± 2.02 (median5.03) years. 184 (57.1%) patients had at least one device replacement, for end-of-life behaviour in 92.3% patients. It was necessary to add an RV lead or to turn off the Hisian lead in 8.6 % patients, due to high threshold or lead failure. In 2 patients the back-up RV lead was switched off due to malfunction. During the follow up 75 (23.2%) patients died, no death was pacemaker related.