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Vol. 54. Issue 1.
Pages 27-32 (January - March 2019)
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Vol. 54. Issue 1.
Pages 27-32 (January - March 2019)
Artículo original
Estimulación definitiva del haz de His mediante herramientas específicas. Experiencia de un centro terciario
Permanent His-bundle pacing using specific tools. Experience in a single centre
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María Teresa Moraleda Salas
Corresponding author
teresamoraleda@hotmail.com

Autor para correspondencia.
, Álvaro Arce León, Pablo Moriña Vázquez, Juan Manuel Fernández Gómez, José Venegas Gamero
Unidad de Arritmias, Servicio de Cardiología, Hospital Juan Ramón Jiménez, Huelva, España
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Tabla 1. Características basales de los pacientes e indicaciones del implante
Resumen
Introducción y objetivos

Desde hace tiempo se conocen los beneficios de la estimulación permanente en His (EPHis) en pacientes con indicación de marcapasos. Para mejorar sus limitaciones se han desarrollado herramientas específicas para la EPHis. El objetivo es describir nuestros resultados con el empleo de dichas herramientas.

Métodos

Estudio descriptivo prospectivo de pacientes con EPHis (implante entre octubre del 2017 y mayo del 2018), utilizándose el introductor Medtronic-C315-His-catheter o la combinación del introductor CPS-Direct-Universal (Abbot) con el subselector CPS-AIMUniversal (Abbot), con el electrodo SelectSecure MRI-SureScan-3830 (Medtronic®, Minneapolis, Minnesota, Estados Unidos). Se analizó el éxito del implante, el tiempo de escopia, la dislocación de electrodos y umbrales agudos, al mes y a los 3 meses de seguimiento.

Resultados

Se incluyó a 36 pacientes con una mediana de edad de 71 años (68-80). El éxito agudo del implante fue del 83,3%, con una mediana de tiempo de escopia de 7,1 min (3,7-14,8). De los pacientes con EPHis, el 70% presentaba QRS fino basal (mediana de QRS basal 80 ms [60-80] y estimulado 80 ms [72-106]). El 23,3% presentaba bloqueo de rama izquierda basal (mediana de QRS basal 150 ms [140-154]) y estimulado de 90 ms [80-100]). La mediana de umbral agudo de His fue de 1,4 voltios (1-2), al mes de 1 voltio (0,75-1,78) y a los 3 meses de 1,25 voltios (0,93-1,5). No hubo dislocación de electrodos en el seguimiento.

Conclusiones

La EPHis es factible y segura en un alto porcentaje de pacientes, con tiempos de escopia razonables y umbrales agudos aceptables, tanto al mes como a los 3 meses de seguimiento.

Palabras clave:
Marcapasos
Estimulación hisiana
Bloqueos suprahisianos
Bloqueos infrahisianos
Abstract
Introduction and objectives

The benefits of permanent His-bundle pacing have been known for a long time. The development of specific tools for selective His pacing aims to overcome its limitations. The purpose of this study is to describe our results obtained with the use of these tools.

Methods

Prospective observational study of patients with permanent His-bundle pacing (from October 2017 to May 2018). The tools used were the Medtronic-C315-His-catheter or the combination of the CPS-Direct-Universal introducer (Abbot) and the CPS-AIM-Universal sub-selector (Abbot), with the SelectSecure MRI-SureScan-3830 lead (Medtronic®, Minneapolis, Minnesota, United States). An analysis was made of the implant success rate, fluoroscopy time, leads dislodgement, and the thresholds (acute, at 1-month and at 3 months of follow-up).

Results

The study included 36 patients with pacing indication. The median age was 71 years (68-80). The acute success of the implant was 83.3%, with a median time of fluoroscopy of 7.1 minutes (3.7-14.8). In patients with permanent His-bundle pacing, 70% had narrow QRS (the median of baseline QRS was 80 ms [60-80] and the median of paced QRS was 80 ms [72-106]). Left bundle branch block was observed in 23.3% of patients (the median of baseline QRS was 150 ms [140-154] and the median of paced QRS was 90 ms [80-100]). The median acute His threshold was 1.4 volts (1-2), was 1 volt (0.75-1.78) at 1 month, and was 1.25 volts (0.93-1.5) at 3 months. There was no leads dislodgement during follow-up.

Conclusions

Permanent His-bundle pacing is feasible and safe in a high percentage of patients. The fluoroscopy time is reasonable. The thresholds are acceptable at 1 month and 3 months of follow-up.

Keywords:
Pacemaker
Permanent His-bundle pacing
Supra-His auriculoventricular block
Infra-His auriculoventricular block

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