December 2014

Pacemaker via His Bundle Pacing

48-aIn a major breakthrough in the field of cardiac electrophysiology in India, leading cardiologists at Fortis Escorts Heart Institute & Research Centre have performed the countrys first pacemaker implant via His Bundle pacing, a technique that saves more lives in the longer run as against the traditional implant procedure.


A team led by Dr T S Kler, HOD cardiology and director, electrophysiology at Fortis Escorts Institute & Research Centre, performed the new procedure on two patients, a 75-year-old man and another 63 years man, who needed a pacemaker implant.

It is the one of the first time that cardiologists in India have performed this procedure. In fact, this is the first time this technique has been uted anywhere in the SAARC region.

A human heart needs a pacemaker when heart rate drops to abnormally low levels either because of inability of natural pulse generator center (sinus node) or when there is electrical block of impulse when it travels from right upper chamber to right lower chamber usually at the AV node or below that. An artificial pacemaker replaces the hearts original electrical impulse generating system with an alternate power generator.

In normal heart functioning, the electricity generated in the upper right chamber of the heart travels to the A-V node (atrioventricular node) & His bundle, which is the bridge between the upper and lower chambers of the heart. This impulse then divides and travels to the left ventricle and the right ventricle. So, naturally speaking, AV Node & His bundle is the point that acts as a natural conductor of electricity from upper chambers to lower chambers of heart. When the AV node is blocked due to a malfunction, the electricity supply interrupts and this necessitates an artificial pacemaker. In traditional pacemaker pacing, which is the norm across the world, there is a long-term risk of patients suffering from heart failure. In fact, 10 to 15 percent people in traditional pacing do tend to suffer from heart failures in the longer run. The alternate His Bundle pacing is the physiological way of pacing and therefore cuts this risk.

In traditional pacemaker implant, the lead of the pacemaker (or its wires) is attached to the right ventricle apex, a point located at the bottom of the lower right chamber of the heart. The electrical input then travels all the way from this lowest point in the heart upwards towards the base. Normal impulse travels from base of heart to its apex. So in apical pacing electrical impulse travels just the opposite to natural way. A section of people (about 10 to 15%) who undergo pacemaker implant through this traditional mode suffer from heart failure due to decrease in pumping capacity of heart caused by right ventricle apical pacing.

The new technology involving pacing through His Bundle pacing cuts this risk of future heart failure to almost zero percent. In this breakthrough technique, which is performed by very few doctors across the world, the pacemaker lead is put on directly on the His bundle, which is the junction between the upper and lower chambers of the heart. This replicates the physiological functioning of the heart as the hearts natural electrical impulses travel in normal human heart.

After conducting the first such two procedures, the doctors are now preparing for a third His Bundle pacing procedure. Right ventricular apical pacing “ as the traditional method is called “ is not an ideal procedure for permanent pacing because of a risk for ventricular function deterioration, mitral valve dysfunction, or proarrhythmic effects. His Bundle pacing provides a safer and better technique of providing electricity to lower chambers of heart. But only problem is it is technically more demanding and takes little extra time for the procedure. The cost of this pacemaker is almost the same as previous available devices.

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