His Bundle Pacing

Programming and Troubleshooting

Charles Slater

Serviço de Arritmias do Hospital Pró-Cardíaco-RJ

@slatercharles1

Disclosure

I have NO financial disclosure or conflits ofinterest with the presented material in this

presentation.

@slatercharles1

Anatomy

1. AV Node2. Non-penetrating portion

3. Penetrating portion4. Branch division

A H V

Using the PBL-STOP Method

EGM 1: Átrio - EGM 2: His - EGM 3: Leadless ECG

EGM 1: Atrium - EGM 2: His - EGM 3: Leadless ECG

Impedance Average 400-600 ohms at HBP location with 3830 lead

Decline in impedance can indicate poor contact of HBP lead to myocardium

Acceptable R wave amplitude 1-3 mV

Consider unipolar configuration if bipolar undersensing

2:1 safety margin

Make sure A EGM not sensed on His channel

Know the indication for implant Afib - A EGM less likely to cross sense

Complete Heart Block – Manage to avoid oversensing

• Keeping pulse width stable, decrement voltage until loss of capture

1.5V 1.0V .5V

Pulse Width Setting: 0.5ms (fixed)

Loss of capture: 0.5V @ 0.5ms

Threshold value: 1.0V @ 0.5ms

PSA + 12 lead rhythm strip

Threshold testing in VVI mode - avoid pseudofusion

Starting output: 5 V @ 1,0 ms

Monitor for changes in morphology

Septal pacing x Non-selective His capture x Selective His capture

Chronic outputs not necessarily 2:1 safety margin

Program at least 1 volt above:

His capture threshold with narrow QRS

Bundle branch block correction threshold

NS-HBP (His + RV) S-HBP (His only) Loss of capture

Threshold fluctuations

5.000 V

1.00 ms

Up to 0,45 mV

Unipolar

Unipolar

Off

90 ms

70 ms

- Next patient, please!

Thank you for your attention

@slatercharles1