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Defining the Distance Between the His Bundle and First Septal Perforator: Implications for Left Bundle Branch Pacing
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  • Matthew Bocchese,
  • Michael Gannon,
  • Pravin Patil,
  • William Van Decker,
  • Isaac Whitman,
  • Edmond Cronin
Matthew Bocchese
Lewis Katz School of Medicine at Temple University

Corresponding Author:[email protected]

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Michael Gannon
Lewis Katz School of Medicine at Temple University
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Pravin Patil
Lewis Katz School of Medicine at Temple University
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William Van Decker
Lewis Katz School of Medicine at Temple University
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Isaac Whitman
Lewis Katz School of Medicine at Temple University
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Edmond Cronin
Lewis Katz School of Medicine at Temple University
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Abstract

Introduction: Left bundle branch pacing (LBBP) is a developing method of native conduction pacing, but cases of injury to the septal perforator arteries during implantation have been reported. Knowing the distance between the His bundle and the first septal perforator artery can help operators implant LBBP leads more safely Methods: Using previously performed coronary CT angiography (CCTA) studies, the distance between the His bundle and the first septal perforator was measured. Results: A total of 50 CCTA studies were included. The mean distance from the His bundle to the first septal perforator (His-SP) along the line connecting the His bundle to the RV apex (His-RV apex) was 27.17 ± 7.7 mm with a range of 13.0 to 44.7 mm. The distance was greater than 2.0 cm in 90% of patients. To standardize this distance among patients with varying cardiac structures, the ratio between the His-SP distance and the His-RV Apex distance was also measured. The mean His-SP:His-RV Apex was 0.302 and the median was 0.298. 86% of patients had a ratio of greater than 0.20. Conclusion: Using this information, operators can aim to implant LBBP leads within 2.0 cm of the His bundle or 20% of the distance between the His bundle and the RV apex with minimal risk of causing vascular injury.
26 Sep 2022Published in Journal of Interventional Cardiac Electrophysiology. 10.1007/s10840-022-01377-9