Long term performance and safety of His bundle pacing: A multicenter experience.
INTRODUCTION
Several single-center short-term studies have demonstrated the feasibility, safety, and positive clinical outcomes of permanent His bundle pacing (HBP). We performed a retrospective study to evaluate long-term technical and safety performances of HBP in a large population of pacemaker patients from two different centers.


METHODS AND RESULTS
The analysis includes 844 patients (345 female, mean age = 75 ± 9 years) who underwent successful permanent HBP for pacemaker indications from 2004 to 2016. The main endpoints were long term electrical performances including pacing threshold, sensing, impedance, and freedom from pacing related complications. The pacing indication was AV Block in 348 (41.2%) patients, sinus node disease in 147 (17.4%), any bradycardia indication in patients with atrial fibrillation in 335 (39.7%) patients and need for cardiac resynchronization therapy in 14 (1.7%) patients. Mean pacing capture thresholds and sensed R waves were 1.6 V and 5.8 mV, respectively at implant and 2.0 V and 6.1 mV at chronic follow-up. During the median follow up of 3 years (interquartile range = 1-6 years), HBP was free of any complication in 91.6% of patients. In the first 368 patients, HBP was achieved using a deflectable curve delivery system, while in 476 using the fixed curve sheath. A significant difference was found in the thresholds (2.4 ± 1.0 V and 1.7 ± 1.1 V, P < .001, respectively) and complications (11.9% and 4.2%, P < .001, respectively) between the two groups.


CONCLUSIONS
Permanent HBP was safe and effective during long-term follow-up. The fixed curved delivery sheath offered significantly better electrical parameters and reliability over time. The results of this multicenter study are consistent with recent studies.
['Zanon|Francesco|F|0000-0003-2673-3918', 'Abdelrahman|Mohamed|M|', 'Marcantoni|Lina|L|', 'Naperkowski|Angela|A|', 'Subzposh|Faiz A|FA|', 'Pastore|Gianni|G|0000-0002-4040-3838', 'Baracca|Enrico|E|', 'Boaretto|Graziano|G|', 'Raffagnato|Paola|P|', 'Tiribello|Antonella|A|', 'Dandamudi|Gopi|G|', 'Vijayaraman|Pugazhendhi|P|0000-0003-2230-100X']
D000200:Action Potentials D000368:Aged D000369:Aged, 80 and over D054537:Atrioventricular Block D001919:Bradycardia D002036:Bundle of His D002304:Cardiac Pacing, Artificial D004868:Equipment Failure D005260:Female D006339:Heart Rate D006801:Humans D007558:Italy D008297:Male D008875:Middle Aged D010138:Pacemaker, Artificial D010414:Pennsylvania D012189:Retrospective Studies D012804:Sick Sinus Syndrome D013997:Time Factors D016896:Treatment Outcome
safety His bundle pacing electrical performances