Table 1. Different device types and configurations for HBP.
| Aim | Indications | Presence of additional V lead(s)* | Sinus rhythm | AF |
|---|---|---|---|---|
| In lieu of RV pacing | AV block Slow AF/flutter |
+ | CRT: His in LV port + RV + A leads in corresponding ports |
DDD: His in A port + RV lead in ventricular port |
| - | DDD: His in RV port† + A lead in A port | VVI: His in only port† | ||
| In lieu of BiV | Failed LV lead implantation Low likelihood of response to BiV Optimization of long AV intervals in heart failure (e.g. in patients with narrow QRS) |
+ | CRT: His in LV port + RV + A leads in corresponding ports CRT: His in RV port† + LV + A leads in corresponding ports |
CRT: His in A port + RV + LV leads in corresponding ports DDD: His in A port and RV or LV# lead in ventricular port |
| - | DDD: His in RV port† + A lead in A port |
VVI: His in only port†) |
||
| His-optimized CRT | Improvement of response to CRT RBBB and selective His capture without correction |
+ | CRT: His in RV port† + LV + A leads in corresponding ports or CRT: His in LV port‖ + LV lead in RV port‡,# + A lead in A port |
DDD: His in A port + LV‡ lead in RV port or CRT: His in A port + RV + LV leads in corresponding ports |
A: atrial; AF: atrial fibrillation; AV: atrioventricular; BiV: biventricular pacing; CRT: cardiac resynchronization therapy; LV: left ventricle; RBBB: right bundle branch block; RV: right ventricle; V: ventricular.
The additional ventricular lead(s) may be used for backup pacing, as an alternative therapy in case HBP is inactivated, or to optimize therapy.
In all instances, if the device is a defibrillator, and a His or LV lead is connected to the RV port, a DF-1 lead should be used, with capping of the IS-1 pin of the lead.
With a His lead in the RV port, sensing must be acceptable
Alternatively, in case of RBBB, an RV lead may be implanted instead of an LV lead (likely to have more shortening effect on ventricular activation time).
Alternatively, the His lead may be connected to the RV port if sensing is good and there is concern for LV dislodgment
Requires a bipolar (not quadripolar) LV lead. Electrical repositioning of the LV lead (e.g. using the ring electrode as cathode) will not be possible.