Defining the Distance Between the His Bundle and First Septal
Perforator: Implications for Left Bundle Branch Pacing
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.