Electrical parameters with His bundle pacing: considerations for automated programming
2019
ABSTRACT Background Programming of His bundle
pacingmay be challenging because current implantable pulse generators are not specifically designed for this
pacingmodality. Objectives Our aim was to evaluate electrical parameters in order to propose preset programming options with different configurations. Methods Data were collected from 50 patients with His
pacingleads connected to various ports (atrial, right ventricular or left ventricular) of pacemakers and defibrillators during a detailed device interrogation which included capture thresholds with various
pacing
vectors,
measurementof timing intervals, and performance of automatic threshold algorithms. Results His bundle-
pacingthresholds were significantly lower during unipolar
pacingcompared to bipolar and extended bipolar polarities. However, current drain was offset due to lower impedance. The His
pace- right ventricular sensed intervals were measured at 40-150ms (mean 85±25ms) with the longest delays in patients with uncorrected
right bundle branch blockand selective His capture. This has implications for ventricular safety
pacingwindows (which were inactivated without evidence of crosstalk) and delays to minimize unnecessary ventricular backup
pacing(which was also affected by
refractory periods). The measured intervals also impacted the performance of automatic threshold algorithms, which performed differently depending on which port the His lead was connected to and did not distinguish between His and myocardial capture. Conclusion Our report provides data which could serve to configure automated programming settings to simplify management of His bundle
pacing.
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