His-Bundle Pacing for Identifying Optimal Ablation Sites in Patients Undergoing Atrioventricular Junction Ablation

Teaching an Old Dog a New Trick KULKARNI, ET AL. HIS-BUNDLE PACING TO GUIDE AV JUNCTION ABLATION

Nitin Kulkarni, Curtiss Moore, Ambarish Pandey, Demetrio Castillo, Colby Ayers, Jose Joglar, Richard Wu

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background: Atrioventricular (AV) junction (AVJ) ablation is conventionally performed by localizing the His-bundle electrogram (HBE). Identification of HBE in the presence of atrial fibrillation (AF) can be difficult, and can make this simple procedure challenging. In this study, we describe our experience with an alternative approach to localize optimal ablation sites using His-bundle pacing (HBP). Methods: Between 1/1/2014 and 12/31/2015, we performed 13 AVJ ablations using the standard electrogram-guided approach and 11 ablations using HBP. All cases utilized a long femoral guiding sheath and an 8-mm-tip electrode radiofrequency (RF) energy ablation catheter. Pacing was performed at high output (10 mA at 2 ms) to initially achieve right bundle branch capture. The catheter was withdrawn until a narrow QRS morphology and increased stim-to-QRS time were observed. HBP was confirmed when paced and native QRS were identical in morphology. RF energy was applied at the site of HBP capture until AV block was observed. Results: Baseline characteristics of patients in each arm were not significantly different. Compared with the standard approach, HBP was associated with trends toward lower RF applications (3 vs. 2, P = 0.16) and shorter mean RF time (208 seconds vs. 128 seconds, P = 0.19). Conclusion: HBP is an effective technique to identify optimal ablation sites during AVJ ablation and may shorten procedure time. HBP can be used to identify the AV node during AF without recording the His potential. Future studies with larger sample size are needed to better characterize the utility of this technique.

Original languageEnglish (US)
JournalPACE - Pacing and Clinical Electrophysiology
DOIs
StateAccepted/In press - 2017

Fingerprint

Bundle of His
Teaching
Dogs
Cardiac Electrophysiologic Techniques
Atrial Fibrillation
Atrioventricular Node
Catheter Ablation
Atrioventricular Block
Thigh
Sample Size
Electrodes
Catheters

Keywords

  • Atrial fibrillation
  • AVJ junction ablation
  • AVN node ablation
  • His-bundle pacing

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

@article{808bb0c402c349f19dd9cfab0a3891f7,
title = "His-Bundle Pacing for Identifying Optimal Ablation Sites in Patients Undergoing Atrioventricular Junction Ablation: Teaching an Old Dog a New Trick KULKARNI, ET AL. HIS-BUNDLE PACING TO GUIDE AV JUNCTION ABLATION",
abstract = "Background: Atrioventricular (AV) junction (AVJ) ablation is conventionally performed by localizing the His-bundle electrogram (HBE). Identification of HBE in the presence of atrial fibrillation (AF) can be difficult, and can make this simple procedure challenging. In this study, we describe our experience with an alternative approach to localize optimal ablation sites using His-bundle pacing (HBP). Methods: Between 1/1/2014 and 12/31/2015, we performed 13 AVJ ablations using the standard electrogram-guided approach and 11 ablations using HBP. All cases utilized a long femoral guiding sheath and an 8-mm-tip electrode radiofrequency (RF) energy ablation catheter. Pacing was performed at high output (10 mA at 2 ms) to initially achieve right bundle branch capture. The catheter was withdrawn until a narrow QRS morphology and increased stim-to-QRS time were observed. HBP was confirmed when paced and native QRS were identical in morphology. RF energy was applied at the site of HBP capture until AV block was observed. Results: Baseline characteristics of patients in each arm were not significantly different. Compared with the standard approach, HBP was associated with trends toward lower RF applications (3 vs. 2, P = 0.16) and shorter mean RF time (208 seconds vs. 128 seconds, P = 0.19). Conclusion: HBP is an effective technique to identify optimal ablation sites during AVJ ablation and may shorten procedure time. HBP can be used to identify the AV node during AF without recording the His potential. Future studies with larger sample size are needed to better characterize the utility of this technique.",
keywords = "Atrial fibrillation, AVJ junction ablation, AVN node ablation, His-bundle pacing",
author = "Nitin Kulkarni and Curtiss Moore and Ambarish Pandey and Demetrio Castillo and Colby Ayers and Jose Joglar and Richard Wu",
year = "2017",
doi = "10.1111/pace.13019",
language = "English (US)",
journal = "PACE - Pacing and Clinical Electrophysiology",
issn = "0147-8389",
publisher = "Wiley-Blackwell",

}

TY - JOUR

T1 - His-Bundle Pacing for Identifying Optimal Ablation Sites in Patients Undergoing Atrioventricular Junction Ablation

T2 - Teaching an Old Dog a New Trick KULKARNI, ET AL. HIS-BUNDLE PACING TO GUIDE AV JUNCTION ABLATION

AU - Kulkarni, Nitin

AU - Moore, Curtiss

AU - Pandey, Ambarish

AU - Castillo, Demetrio

AU - Ayers, Colby

AU - Joglar, Jose

AU - Wu, Richard

PY - 2017

Y1 - 2017

N2 - Background: Atrioventricular (AV) junction (AVJ) ablation is conventionally performed by localizing the His-bundle electrogram (HBE). Identification of HBE in the presence of atrial fibrillation (AF) can be difficult, and can make this simple procedure challenging. In this study, we describe our experience with an alternative approach to localize optimal ablation sites using His-bundle pacing (HBP). Methods: Between 1/1/2014 and 12/31/2015, we performed 13 AVJ ablations using the standard electrogram-guided approach and 11 ablations using HBP. All cases utilized a long femoral guiding sheath and an 8-mm-tip electrode radiofrequency (RF) energy ablation catheter. Pacing was performed at high output (10 mA at 2 ms) to initially achieve right bundle branch capture. The catheter was withdrawn until a narrow QRS morphology and increased stim-to-QRS time were observed. HBP was confirmed when paced and native QRS were identical in morphology. RF energy was applied at the site of HBP capture until AV block was observed. Results: Baseline characteristics of patients in each arm were not significantly different. Compared with the standard approach, HBP was associated with trends toward lower RF applications (3 vs. 2, P = 0.16) and shorter mean RF time (208 seconds vs. 128 seconds, P = 0.19). Conclusion: HBP is an effective technique to identify optimal ablation sites during AVJ ablation and may shorten procedure time. HBP can be used to identify the AV node during AF without recording the His potential. Future studies with larger sample size are needed to better characterize the utility of this technique.

AB - Background: Atrioventricular (AV) junction (AVJ) ablation is conventionally performed by localizing the His-bundle electrogram (HBE). Identification of HBE in the presence of atrial fibrillation (AF) can be difficult, and can make this simple procedure challenging. In this study, we describe our experience with an alternative approach to localize optimal ablation sites using His-bundle pacing (HBP). Methods: Between 1/1/2014 and 12/31/2015, we performed 13 AVJ ablations using the standard electrogram-guided approach and 11 ablations using HBP. All cases utilized a long femoral guiding sheath and an 8-mm-tip electrode radiofrequency (RF) energy ablation catheter. Pacing was performed at high output (10 mA at 2 ms) to initially achieve right bundle branch capture. The catheter was withdrawn until a narrow QRS morphology and increased stim-to-QRS time were observed. HBP was confirmed when paced and native QRS were identical in morphology. RF energy was applied at the site of HBP capture until AV block was observed. Results: Baseline characteristics of patients in each arm were not significantly different. Compared with the standard approach, HBP was associated with trends toward lower RF applications (3 vs. 2, P = 0.16) and shorter mean RF time (208 seconds vs. 128 seconds, P = 0.19). Conclusion: HBP is an effective technique to identify optimal ablation sites during AVJ ablation and may shorten procedure time. HBP can be used to identify the AV node during AF without recording the His potential. Future studies with larger sample size are needed to better characterize the utility of this technique.

KW - Atrial fibrillation

KW - AVJ junction ablation

KW - AVN node ablation

KW - His-bundle pacing

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U2 - 10.1111/pace.13019

DO - 10.1111/pace.13019

M3 - Article

JO - PACE - Pacing and Clinical Electrophysiology

JF - PACE - Pacing and Clinical Electrophysiology

SN - 0147-8389

ER -