his bundle pacing - sobrac · his bundle pacing programming and troubleshooting charles slater...
TRANSCRIPT
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His Bundle Pacing
Programming and Troubleshooting
Charles Slater
Serviço de Arritmias do Hospital Pró-Cardíaco-RJ
@slatercharles1
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Disclosure
I have NO financial disclosure or conflits ofinterest with the presented material in this
presentation.
@slatercharles1
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Anatomy
1. AV Node2. Non-penetrating portion
3. Penetrating portion4. Branch division
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A H V
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Using the PBL-STOP Method
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EGM 1: Átrio - EGM 2: His - EGM 3: Leadless ECG
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EGM 1: Atrium - EGM 2: His - EGM 3: Leadless ECG
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Impedance Average 400-600 ohms at HBP location with 3830 lead
Decline in impedance can indicate poor contact of HBP lead to myocardium
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Acceptable R wave amplitude 1-3 mV
Consider unipolar configuration if bipolar undersensing
2:1 safety margin
Make sure A EGM not sensed on His channel
Know the indication for implant Afib - A EGM less likely to cross sense
Complete Heart Block – Manage to avoid oversensing
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• Keeping pulse width stable, decrement voltage until loss of capture
1.5V 1.0V .5V
Pulse Width Setting: 0.5ms (fixed)
Loss of capture: 0.5V @ 0.5ms
Threshold value: 1.0V @ 0.5ms
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PSA + 12 lead rhythm strip
Threshold testing in VVI mode - avoid pseudofusion
Starting output: 5 V @ 1,0 ms
Monitor for changes in morphology
Septal pacing x Non-selective His capture x Selective His capture
Chronic outputs not necessarily 2:1 safety margin
Program at least 1 volt above:
His capture threshold with narrow QRS
Bundle branch block correction threshold
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NS-HBP (His + RV) S-HBP (His only) Loss of capture
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Threshold fluctuations
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5.000 V
1.00 ms
Up to 0,45 mV
Unipolar
Unipolar
Off
90 ms
70 ms
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- Next patient, please!
Thank you for your attention
@slatercharles1