title: Comparison of single and double vein approaches for His bundle ablation and pacemaker placement for symptomatic rapid atrial fibrillation.
abstract: BACKGROUND
  His Bundle ablation (HBA) with permanent pacemaker (PPM) implantation is an effective strategy for controlling heart rate in symptomatic patients with rapid atrial fibrillation (AF), resistant to pharmacologic therapy. The standard double vein (DV) approach involves mapping and HBA from a femoral approach to achieve complete heart block (CHB), while single chamber (SC), dual chamber (DC), or biventricular (BiV) PPM is then placed via a subclavian approach.
  
  
  METHODS
  We compared 7 patients with drug-resistant rapid AF who underwent the standard DV approach to 8 patients who underwent a single vein (SV) approach, in which HBA and PPM implantation were performed through the subclavian vein. The two groups were compared for acute success in creating CHB, total procedure and fluoroscopy times and patient discomfort. Results are expressed as mean +/- standard error (SEM).
  
  
  RESULTS
  The procedure times for the SV versus DV were 70.4 +/- 11.4 v 100.0 +/- 19.2 min, and the fluoroscopy times, 13.9 +/- 3.1 (SV) v 13.0 +/- 2.9 (DV). All patients were discharged in stable condition with CHB and SC, DC pacemaker or BiV/Implantable Cardioverter Defibrillator (ICD). CHB with symptomatic improvement was maintained in all patients over a mean follow-up period of 22.6 months (SV), and 9.6 months (DV).
  
  
  CONCLUSIONS
  The SV approach for HBA combined with PPM implantation was at least as effective and may be more efficient than the classic DV approach, and should be considered as an alternative to DV technique to reduce procedural time and patient discomfort.
authors.affiliation: Henry Low Heart Center, Hartford Hospital, University of Connecticut School of Medicine, Hartford, CT 06102, USA.
authors.forename: Ravishankar
authors.initials: R
authors.lastname: Kalaga
authors.forename: Rosemary
authors.initials: R
authors.lastname: Kahr
authors.forename: Magdy
authors.initials: M
authors.lastname: Migeed
authors.forename: Ravi
authors.initials: R
authors.lastname: Yarlagadda
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Clyne
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging / Q000517:prevention & control* / Q000601:surgery*; D002036:Bundle of His / Q000000981:diagnostic imaging / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D003131:Combined Modality Therapy; D005260:Female; D006329:Heart Conduction System / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D010138:Pacemaker, Artificial; D019919:Prosthesis Implantation / Q000379:methods; D011667:Pulmonary Veins / Q000000981:diagnostic imaging / Q000601:surgery*; D011859:Radiography