title: Electrophysiological observations of acute His bundle injury during permanent His bundle pacing.
abstract: Permanent His bundle pacing (HBP) is a physiological alternative to right ventricular pacing (RVP). Catheter manipulation during HBP can cause trauma to the His bundle during implantation. We sought to determine acute and long-term incidence of His bundle (HB) injury with HBP.
  
  
  
  Patients undergoing permanent HBP at Geisinger Wyoming Valley Medical Center from 2006 to 2014 formed the study group. Patients with pre-existing His-Purkinje disease (HPD) were excluded from the study. Any development of new bundle branch block (BBB) or AV block (B) during acute HBP lead-induced block was recorded. Resolution of AVB and/or BBB was documented.
  
  
  
  HBP was attempted in 450 patients. In 358 patients without HPD, 28 (7.8%) developed acute HB injury in the form of complete AVB (4, 1.1%), RBBB (21, 5.9%) or LBBB (3, 0.8%) during HBP lead placement. In all 7 patients with AVB or LBBB, conduction completely recovered. The HB electrogram from the lead displayed injury current in all 7 patients. Lead-induced RBBB resolved in 12 of 21 patients and persisted in 9 (2.5%) patients. Pacing from the HBP lead resulted in correction of acute conduction block in 27 of 28 patients and 8 of 9 patients with chronic RBBB. None of the patients with transient conduction block developed new conduction disease during follow-up of 21±19months.
  
  
  
  Despite acute trauma to HB in 7.8% of patients undergoing permanent HBP, complete resolution of conduction block occurred in 19 of 28 patients (68%). RBBB persisted in 9 patients (32%) but mostly normalized with HBP.
authors.affiliation: Geisinger Wyoming Valley Medical Center, Wilkes-Barre, PA. Electronic address: pvijayaraman1@geisinger.edu.
authors.forename: Pugazhendhi
authors.initials: P
authors.lastname: Vijayaraman
authors.affiliation: Indiana University, Indianapolis, IN.
authors.forename: Gopi
authors.initials: G
authors.lastname: Dandamudi
authors.affiliation: Virginia Commonwealth University Health System, Richmond, VA.
authors.forename: Kenneth A
authors.initials: KA
authors.lastname: Ellenbogen
mesh_terms: D000208:Acute Disease; D000368:Aged; D054537:Atrioventricular Block / Q000453:epidemiology* / Q000517:prevention & control*; D002036:Bundle of His; D002037:Bundle-Branch Block / Q000453:epidemiology* / Q000517:prevention & control*; D002304:Cardiac Pacing, Artificial / Q000706:statistics & numerical data*; D015984:Causality; D005260:Female; D005500:Follow-Up Studies; D006335:Heart Injuries / Q000175:diagnosis / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D010414:Pennsylvania / Q000453:epidemiology; D012008:Recurrence; D012307:Risk Factors; D016896:Treatment Outcome
keywords: Bundle branch block; Complete heart block; His bundle injury; His bundle pacing; Permanent His bundle pacing