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Europace 2000 2(3):187-190; doi:10.1053/eupc.2000.0111
© 2000 by European Society of Cardiology
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LEADING ARTICLE

Temporary pacing after His bundle ablation for drug-refractory atrial fibrillation: a risky enterprise?

E. M. Buys, N. M. Van Hemel, E. R. Jessurun, J. C. Kelder and P. F. H. M. Van Dessel

Department of Cardiology, St Antonius Hospital Nieuwegein, The Netherlands

Abstract

AIM: In patients with and without a permanent pacemaker His bundle ablation was performed for symptomatic drug-refractory atrial fibrillation. This study was performed to examine the complications of temporary pacing in patients without an already implanted pacemaker.

METHODS AND RESULTS: Between January 1996 and December 1998, 152 consecutive patients, both referred and our own (non-referred), underwent His bundle ablation for drug-refractory atrial fibrillation. Primary end-point complications were temporary lead dislodgement requiring immediate repositioning (1), severe arrhythmia (2), death (3) and persistent damage to an already implanted pacing system (4). Secondary end-points were malsensing and malpacing of the temporary lead, and blood vessel problems. Lead dislodgement of the temporary pacemaker occurred in three patients (2·9%), all of whom were in the referred group. Severe arrhythmia and death did not occur. Persistent damage of the already implanted pacing system was not observed. Secondary end-points occurred in 15·8% of the patients and were successfully managed by a conservative approach.

CONCLUSION: Permanent pacemaker implantation is recommended prior to His bundle ablation in order to avoid haemodynamic deterioration due to dislocation of the temporary pacemaker lead. RF current used for His bundle ablation caused no permanent damage to permanent pacing systems.

Key Words: His bundle ablation, temporary pacing

Correspondence: N. M. van Hemel, MD, St Antonius Hospital, Department of Cardiology, Koekoekslaan 1, 3435 CM Nieuwegein, The Netherlands.


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How to make sure complications are avoided after an otherwise safe procedure
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