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Acta Cardiologica

ISSN: 0001-5385 (Print) 0373-7934 (Online) Journal homepage: http://www.tandfonline.com/loi/tacd20

His-bundle pacing using dual-chambercardioverter–defibrillator in patients with chronicatrial fibrillation: different pacing and sensingfeatures

Agnieszka Sławuta, Dariusz Biały, Dorota Zyśko, Grzegorz Mazur & JacekGajek

To cite this article: Agnieszka Sławuta, Dariusz Biały, Dorota Zyśko, Grzegorz Mazur & JacekGajek (2017) His-bundle pacing using dual-chamber cardioverter–defibrillator in patients withchronic atrial fibrillation: different pacing and sensing features, Acta Cardiologica, 72:3, 343-344,DOI: 10.1080/00015385.2017.1305169

To link to this article: https://doi.org/10.1080/00015385.2017.1305169

Published online: 31 Mar 2017.

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343ACTA CARDIOLOGICA 2017; 72(3): 343–344

Address for correspondence:

Jacek Gajek, M.D., Ph.D.,Dept. of Cardiology, Wroclaw Medical University, Borowska 213, 50-556 Wrocław, Poland.E-mail: jacek.gajek@interia.pl

Received 13 March 2016; revision accepted for publication 18 April 2016.

A direct His-bundle pacing wins popularity as more implantation centres use this technique. Maintaining physiologic ventricular activation (in patients with nar-row QRS complex) or even correcting the LBBB (in patients with pre-existing LBBB), are of particular importance. The most interesting population are indi-viduals with chronic atrial fibrillation. If there is no need for atrial pacing/sensing, standard dual-chamber devices can be used. This reduces procedure costs and ensures ventricular pacing in case of improper or high threshold His-bundle pacing. In patients with severe left ventricu-lar systolic dysfunction this way of using the dual-cham-ber ICD can be a solution for all the issues.

We present two cases of patients with chronic, slow atrial fibrillation requiring pacing, left ventricular systolic dysfunction and/or ventricular arrhythmia. The ICD was implanted using the atrial channel for His-bundle pacing/sensing. The ICD electrode was placed in the right ven-tricle apex for back-up pacing and arrhythmia detection and treatment. These two cases differ in terms of His-

His-bundle pacing using dual-chamber cardioverter- defibrillator in patients with chronic atrial fibrillation: different pacing and sensing features

Agnieszka SŁAWUTA1, MD, PhD; Dariusz BIAŁY2, MD, PhD; Dorota ZYŚKO3, MD, PhD; Grzegorz MAZUR4, MD, PhD; Jacek GAJEK2, MD, PhD1Department of Cardiology, Klodzko County Hospital, Kłodzko, Poland; 2Department of Cardiology, Wroclaw Medical University, Wrocław, Poland; 3Department of Emergency Medicine, Wroclaw Medical University, Wrocław, Poland; 4Department of Internal and Occupational Medicine and Hypertension, Wroclaw Medical University, Wrocław, Poland.

Keywords Direct His-bundle pacing – atrial fibrillation.

bundle pacing and sensing features in the atrial channel which is depicted in the figure. In the upper panel the direct His-bundle pacing occurs to be selective, detected by the device as AP/VS but the sensing of the visible His-bundle potential is not possible, so the spontaneous QRS complex is recognized as PVC. In the lower panel the pacing is not selective, nevertheless detected by the device as AP/VS, and the sensing of the His-bundle potential and subsequent QRS complex are recognized as AS/VS.

CONCLUSION

As the implantation of dual-chamber ICDs for His-bundle pacing/sensing in patients with atrial fibrillation may spread in the near future, understanding of these atypical electrocardiograms is of a paramount importance.

CONFLICT OF INTEREST: none.

http://dx.doi.org/10.1080/00015385.2017.1305169© 2017 Belgian Society of Cardiology

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A. Sławuta et al.344

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