Browsing by Author "Vijayaraman, Pugazhendhi"

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    Permanent His Bundle Pacing in Patients With Congenital Complete Heart Block: A Multicenter Experience
    (Elsevier, 2021-04) Dandamudi, Gopi; Simon, Joel; Cano, Oscar; Master, Vivak; Koruth, Jacob S.; Naperkowski, Angela; Kean, Adam C.; Schaller, Robert; Ellenbogen, Kenneth A.; Kron, Jordana; Vijayaraman, Pugazhendhi; Pediatric Dentistry, School of Dentistry
    Objectives This study retrospectively assessed the safety and efficacy of permanent His bundle pacing (HBP) in patients with congenital complete heart block (CCHB). Background HBP has become an accepted form of pacing in adults. Its role in CCHB is not known. Methods Seventeen patients with CCHB who underwent successful HBP were analyzed at 6 academic centers between 2016 and 2019. Nine patients had de novo implants, and 8 patients had previous right ventricular (RV) leads. Three RV paced patients had reduced left ventricular ejection fractions at the time of HBP. Implant/follow-up device parameters, New York Heart Association functional class, QRS duration, and left ventricular ejection fraction data were analyzed. Results Patients’ mean age was 27.4 ± 11.3 years, 59% were women, and mean follow-up was 385 ± 279 days. The following parameters were found to be statistically significant between implant and follow-up, respectively: impedance, 602 ± 173 Ω versus 460 ± 80 Ω (p < 0.001); and New York Heart Association functional class, 1.7 ± 0.9 versus 1.1 ± 0.3 (p = 0.014). In patients with previous RV pacing, HBP resulted in a significant decrease in QRS duration: 167.1 ± 14.3 ms versus 118.3 ± 13.9 ms (p < 0.0001). In de novo implants, HBP resulted in increases in QRS duration compared with baseline: 111.1 ± 19.4 ms versus 91.0 ± 4.8 ms (p = 0.016). Other parameters exhibited no statistically significant differences. During follow-up, 2 patients required lead revision due to elevated pacing thresholds. Conclusions HBP seems to be safe and effective, with improvement in clinical outcomes in patients with CCHB. Larger studies with longer follow-up periods are required to confirm our findings.
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    Permanent His Bundle Pacing: Electrophysiological and Echocardiographic Observations From Long-Term Follow-Up
    (Wiley, 2017-07) Vijayaraman, Pugazhendhi; Dandamudi, Gopi; Lustgarten, Daniel; Ellenbogen, Kenneth A.; Department of Medicine, IU School of Medicine
    Background Permanent His bundle pacing (HBP) is a physiological alternative to right ventricular pacing. It is not known whether HBP can cause His-Purkinje conduction (HPC) disease. The aim of our study is to assess His bundle capture and its effect on left ventricular (LV) function in long-term follow-up and to determine HPC at the time of pulse generator change (GC) in patients with chronic HBP. Methods HB electrograms were recorded from the pacing lead at implant and GC. HBP QRS duration (QRSd), His-ventricular (HV) intervals, and HB pacing thresholds at GC were compared with implant measurements. HPC was assessed by pacing at cycle lengths of 700 ms, 600 ms, and 500 ms at GC. LV internal diameters, ejection fraction (EF), and valve dysfunction at baseline were compared with echocardiography during follow-up. Results GC was performed in 20 patients (men 13; age 74 ± 14 years) with HBP at 70 ± 24 months postimplant. HV intervals remained unchanged from initial implant (44 ± 4 ms vs 45 ± 4 ms). During HBP at 700 ms, 600 ms, and 500 ms (n = 17), consistent 1:1 HPC was present. HBP QRSd remained unchanged during follow-up (117 ± 20 ms vs 118 ± 23 ms). HBP threshold at implant and GC was 1.9 ± 1.1 V and 2.5 ± 1.2 V @ 0.5 ms. Despite high pacing burden (77 ± 13%), there was no significant change in LVEF (50 ± 14% at implant) during follow-up (55 ± 6%, P = 0.06). Conclusions HBP does not appear to cause new HPC abnormalities and is associated with stable HBP QRSd during long-term follow-up. Despite high pacing burden, HBP did not result in deterioration of left ventricular systolic function or cause new valve dysfunction.
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    Permanent His bundle pacing: Recommendations from a Multicenter His Bundle Pacing Collaborative Working Group for standardization of definitions, implant measurements, and follow-up
    (Elsevier, 2017) Vijayaraman, Pugazhendhi; Dandamudi, Gopi; Zanon, Francesco; Sharma, Parikshit S.; Tung, Roderick; Huang, Weijian; Koneru, Jayanthi; Tada, Hiroshi; Ellenbogen, Kenneth A.; Lustgarten, Daniel L.; Medicine, School of Medicine
    His bundle pacing (HBP) prevents ventricular dyssynchrony and its long-term consequences by preserving normal electrical activation of the ventricles. Since the original description of permanent HBP in 2000, the adoption of HBP has increased over the past several years. However, the reporting of procedural and clinical outcomes to date is not uniform. This article is a collaboration between several implanters with significant experience in HBP to establish a uniform set of definitions encompassing the different forms of HBP as well as define a standardized approach to gathering data end points to ensure consistency in reported outcomes.