His Bundle Pacing hiting mainstream

HIS Bundle Pacing

by lefty2 - 2019-03-15 14:51:17

Hi,

I have a CRT-D and they are having trouble placing the 3rd wire. I have a choice of either having it done via surgery or considering a HIS Bundle pacing wire.

Just curious if your EF has increased with the procedure?

His Bundle Pacing

by fox30 - 2019-03-15 17:49:49

Yes My EF did increase after HBP.

Actually my EF, pre PM insertion, was at the lower limits of normal. I was not in overt HF. I got the PM because I had Second degree Heart block that was exercise induced The EP doc implanted a LV lead AND a His BUndle lead.I have not needed the LV Lead which would have been part of BiV pacing.This  was in 2015 and the EP doc was just beginning to do do HBP and considered  the LV lead as back-up since at implantation he was able to correct the LBBB pattern with a normal qrs complex.

On the operative note the EP doc described the situation as the patient having "mildly decreased left ventricualr function". 

The pre implant echo was read as "lower limits normal LV functionl.Estimated EF 50-54."

6 weeks later echo read as "LV function is normal .Estimated EF 55-5 9%.

Significantly 3 mos. later I was once again again to run at about the same pace as before I developed the LBBB.

Several review articles have indicated that HBP is at least as effective as Bi V pacing for CRT.

There is a learning curve with HB pacing and ideally someone would want their doctor to have had sufficient experience with the procedure for him to be confident.

I hope what ever version of CRT you get works well for you. 

Fox30

Yes

by Newbie4444 - 2019-03-15 20:38:28

I just got mine placed last Friday at University of Pennsylvania hospital. I didn’t even known His Bundle pacing was a thing. When I came out of surgery, the doc gave me a science lesson and showed me that they had placed the 2nd lead in the bundle of His. He said it’s been done this way for the past 3-4 years and shows a much lower risk of congestive heart failure long term. 

Who was your Doctor?

by lefty2 - 2019-03-17 11:50:38

I am seen by a cardiologist at a NYC hosptial and they do not seem to have anyone who has done many HIS bundle pacing procedure. From what I have read, you should see one who has done many procedures.

Who do you recommend?

His Bundle Pacing

by fox30 - 2019-03-17 15:16:41

Many centers in the country are doing HB pacing now. Some of them are

Geisinger Clinic in Pennsylvania,University of Chicago, University of Vermont,Virginia Commonwealth Medical School,UCLA,Debakey Cardiology Group at Houston Methodist Hospital, Rush Medical Center, Indian University School of Medicine,Cleveland CLinic, and  Dr. John Mandrola in Kentucky to name a few. 

Evaluating his bundle

by Cwilcox - 2019-03-31 22:17:01

I have not yet received a pacemaker, but may in the near future. My doctor recommended his bundle to reduce the risk of heart failure, based on my age and the amount of time I would be paced.

I have been hesitant to get a pacemaker due to the risk of heart failure, but his bundle seems to be the way to go. I am having trouble finding doctors in NY state that do the procedure frequently enough where I am comfortable with their experience. 

his bundle

by fox30 - 2019-04-01 09:23:26

As were some other writers I am puzzeled about why a PM was recommended for treatment of PVCs.Patients with large numbers of PVCs are at risk for the development of a cardiomyopathy and heart failure.Ep docs tpically consider "large numbers" to be 20,000 per day or more.The number of PVCs. you quoted that you have is typically not a number that would concern cardiologists.Patients with large number of PVCs may be candidates for an ablation procedure in which the EP doc localizes the site of the origin of the PVCs and then abates the area with radiofrequency waves .

If I do not not  understand the reason for recommending a PM and you want to consult with a doc with His Bundle experience you might give the cardiology deparment at Columbia Medical School a call. They have a very well known and respected EP section but I do not know specifically their experience or lack of experience with His Bundle.