Question

His bundle area pacing.

Hint:

His bundle pacing offers a more physiologic form of pacing compared to traditional methods, especially in patients with conduction system diseases.

Answer 1

Step 1: Understanding His Bundle Pacing:
His bundle pacing is a technique that involves placing a pacemaker lead at the His bundle, which allows for more physiologic conduction and synchrony compared to traditional ventricular pacing.
Step 2: Indications for His Bundle Pacing:
1. Bradycardia with Conduction System Disease: It is especially beneficial in patients with sick sinus syndrome or atrioventricular block.
2. Heart Failure: His bundle pacing has shown potential in improving ventricular synchrony, which can help in patients with heart failure who require pacing.
3. Preventing Long-Term Effects of Right Ventricular Pacing: His bundle pacing may be preferred over right ventricular pacing as it may reduce the risk of pacing-induced cardiomyopathy.

Step 3: Procedure:
1. Lead Placement: The pacing lead is inserted through a catheter and positioned at the His bundle using fluoroscopy.
2. Testing and Adjustment: Once the lead is in place, testing is done to confirm proper capture and threshold, ensuring the pacing is effective.

Step 4: Potential Complications:
1. Lead Displacement: There is a risk of lead displacement due to its delicate positioning at the His bundle.
2. Infection: As with any pacemaker placement, infection is a risk that needs to be managed.
3. Failure to Capture: The pacing lead may fail to capture the heart, requiring repositioning or replacement.