RESUMO
BACKGROUND Pulsed field ablation (PFA), as a non-thermal ablation modality, has received increasing attention. The aim of this study was to evaluate the effect of PFA upon His bundle via its implementation with different voltages on the maximum His bundle potential in canines, providing scientific basis for clinical application. MATERIAL AND METHODS Pulsed electrical field energy was delivered from a ablation catheter to the maximum His potential of 7 dogs, followed by a series of electrogram and histology assessments. RESULTS The baseline AH and HV intervals were 55.3±3.7 ms (range, 53.0-59.0 ms), and 34.9±1.3 ms (range, 34.0-36.0 ms), respectively, which were elevated to 65.0±5.4 ms (range, 59.0-70.0 ms) and 35.7±2.7 ms (range, 34.0-37.0 ms) after PFA. Before ablation and immediately after the recovery of third-degree AVB, the AH interval was prolonged (P<0.05) while the HV interval remained unchanged (P>0.05). After ablation, all 7 canines experienced transient third-degree AVB, with a voltage-dependent duration. Masson staining results revealed no apparent damage in His bundle cells. CONCLUSIONS Within a certain voltage range of pulse electric field, ablation of the maximum His potential in canines can result in transient third-degree AVB, providing a new route for guiding safe ablation of para-Hisian arrhythmia.
Assuntos
Fascículo Atrioventricular , Ablação por Cateter , Animais , Cães , Fascículo Atrioventricular/fisiopatologia , Ablação por Cateter/métodos , Eletrocardiografia/métodos , Masculino , Potenciais de Ação/fisiologiaRESUMO
PURPOSE OF THE REVIEW: Cardiac pacing has evolved in recent years currently culminating in the specific stimulation of the cardiac conduction system (conduction system pacing, CSP). This review aims to provide a comprehensive overview of the available literature on CSP, focusing on a critical classification of studies comparing CSP with standard treatment in the two fields of pacing for bradycardia and cardiac resynchronization therapy in patients with heart failure. The article will also elaborate specific benefits and limitations associated with CSP modalities of His bundle pacing (HBP) and left bundle branch area pacing (LBBAP). RECENT FINDINGS: Based on a growing number of observational studies for different indications of pacing therapy, both CSP modalities investigated are advantageous over standard treatment in terms of narrowing the paced QRS complex and preserving or improving left ventricular systolic function. Less consistent evidence exists with regard to the improvement of heart failure-related rehospitalization rates or mortality, and effect sizes vary between HBP and LBBAP. LBBAP is superior over HBP in terms of lead measurements and procedural duration. With regard to all reported outcomes, evidence from large scale randomized controlled clinical trials (RCT) is still scarce. CSP has the potential to sustainably improve patient care in cardiac pacing therapy if patients are appropriately selected and limitations are considered. With this review, we offer not only a summary of existing data, but also an outlook on probable future developments in the field, as well as a detailed summary of upcoming RCTs that provide insights into how the journey of CSP continues.
Assuntos
Bradicardia , Estimulação Cardíaca Artificial , Terapia de Ressincronização Cardíaca , Insuficiência Cardíaca , Humanos , Insuficiência Cardíaca/terapia , Insuficiência Cardíaca/fisiopatologia , Terapia de Ressincronização Cardíaca/métodos , Estimulação Cardíaca Artificial/métodos , Bradicardia/terapia , Bradicardia/fisiopatologia , Sistema de Condução Cardíaco/fisiopatologia , Fascículo Atrioventricular/fisiopatologia , Resultado do TratamentoRESUMO
Left bundle branch pacing (LBBP) has been subject to increasing interest over the last few years due to its capacity for physiological conduction and its advantages compared to His bundle pacing. His bundle pacing has certain limitations, such as a small pacing area for the His bundle, a high threshold that leads to battery depletion, a low R-wave amplitude that may result in atrial or His oversensing, and ventricular signal undersensing. In this case series, four patients (two female and two male) aged 62.2 ± 8.4 years old with symptomatic sick sinus disease and no scar tissue in the interventricular septum underwent LBBP. All LBBPs were done with standard LBBP using a lumenless SelectSecure 3830 lead (Medtronic®, Minneapolis, USA) with a fixed helix. The lead parameters showed a good R-wave amplitudes (13 ± 7.4 mV) and a low threshold (0.77 ± 0.17 V @ 0.4 ms). All patients were discharged on the next day. During follow-up period of 13.3 ± 12.9 months, all patients were well and no complications were noted. In conclusion, LBBP may be as an alternative of novel conduction pacing techniques and can be done relatively easy and safe, even with limited experience center.
Assuntos
Fascículo Atrioventricular , Estimulação Cardíaca Artificial , Eletrocardiografia , Humanos , Feminino , Pessoa de Meia-Idade , Masculino , Fascículo Atrioventricular/fisiopatologia , Estimulação Cardíaca Artificial/métodos , Idoso , Síndrome do Nó Sinusal/terapia , Resultado do Tratamento , Marca-Passo Artificial , Bloqueio de Ramo/terapia , Bloqueio de Ramo/fisiopatologiaRESUMO
BACKGROUND: The excitable gap (EG), defined as the excitable tissue between two subsequent wavefronts of depolarization, is critical for maintaining reentry that underlies deadly ventricular arrhythmias. EG in the His-Purkinje Network (HPN) plays an important role in the maintenance of electrical wave reentry that underlies these arrhythmias. OBJECTIVE: To determine if rapid His bundle pacing (HBP) during reentry reduces the amount of EG in the HPN and ventricular myocardium to suppress reentry maintenance and/or improve defibrillation efficacy. METHODS: In a virtual human biventricular model, reentry was initiated with rapid line pacing followed by HBP delivered for 3, 6, or 9 s at pacing cycle lengths (PCLs) ranging from 10 to 300 ms (n=30). EG was calculated independently for the HPN and myocardium over each PCL. Defibrillation efficacy was assessed for each PCL by stimulating myocardial surface EG with delays ranging from 0.25 to 9 s (increments of 0.25 s, n=36) after the start of HBP. Defibrillation was successful if reentry terminated within 1 s after EG stimulation. This defibrillation protocol was repeated without HBP. To test the approach under different pathological conditions, all protocols were repeated in the model with right (RBBB) or left (LBBB) bundle branch block. RESULTS: Compared to without pacing, HBP for >3 seconds reduced average EG in the HPN and myocardium across a broad range of PCLs for the default, RBBB, and LBBB models. HBP >6 seconds terminated reentrant arrhythmia by converting HPN activation to a sinus rhythm behavior in the default (6/30 PCLs) and RBBB (7/30 PCLs) models. Myocardial EG stimulation during HBP increased the number of successful defibrillation attempts by 3%-19% for 30/30 PCLs in the default model, 3%-6% for 14/30 PCLs in the RBBB model, and 3%-11% for 27/30 PCLs in the LBBB model. CONCLUSION: HBP can reduce the amount of excitable gap and suppress reentry maintenance in the HPN and myocardium. HBP can also improve the efficacy of low-energy defibrillation approaches targeting excitable myocardium. HBP during reentrant arrhythmias is a promising anti-arrhythmic and defibrillation strategy.
Assuntos
Fascículo Atrioventricular , Humanos , Fascículo Atrioventricular/fisiopatologia , Arritmias Cardíacas/terapia , Estimulação Cardíaca Artificial/métodos , Cardioversão Elétrica/métodos , Ventrículos do Coração/fisiopatologia , Modelos CardiovascularesRESUMO
Ventricular backup leads may be considered in selected patients with His bundle pacing (HBP), but it remains unknown to what extent this is useful. A total of 184 HBP patients were studied. At last follow-up, 147 (79.9%) patients retained His bundle capture at programmed output. His bundle pacing lead revision was performed in 5/36 (13.9%) patients without a backup lead and in 3/148 (2.0%) patients with a backup lead (P = 0.008). One patient without a backup lead had syncope due to atrial oversensing. Thus, implantation of ventricular backup leads may avoid lead revision and adverse events in selected HBP patients.
Assuntos
Fascículo Atrioventricular , Estimulação Cardíaca Artificial , Marca-Passo Artificial , Humanos , Fascículo Atrioventricular/fisiopatologia , Masculino , Feminino , Estimulação Cardíaca Artificial/métodos , Idoso , Resultado do Tratamento , Pessoa de Meia-Idade , Idoso de 80 Anos ou mais , Estudos Retrospectivos , Fatores de Tempo , Eletrodos ImplantadosRESUMO
Since the introduction of left bundle branch pacing (LBBP), a search for precise parameters confirming successful capture of conduction system was conducted. Most of the proposed electrocardiographic criteria refer to patients with narrow QRS complexes. We present a patient with heart failure in whom cardiac resynchronization was achieved using conduction system pacing. While measuring left ventricular activation time, an isoelectric interval of 74 ms between stimulus and R-wave appeared resulting in prolongation of V6 RWPT to 124 ms. Considering the immediate narrowing of QRS complexes following LBBP, the observed latency most probably reflects prolonged conduction time through the His-Purkinje system.
Assuntos
Bloqueio de Ramo , Eletrocardiografia , Insuficiência Cardíaca , Humanos , Insuficiência Cardíaca/fisiopatologia , Insuficiência Cardíaca/terapia , Bloqueio de Ramo/fisiopatologia , Bloqueio de Ramo/terapia , Masculino , Terapia de Ressincronização Cardíaca/métodos , Fascículo Atrioventricular/fisiopatologia , Sistema de Condução Cardíaco/fisiopatologia , Resultado do Tratamento , Idoso , Pessoa de Meia-IdadeRESUMO
AIMS: Monitoring current of injury (COI) during left bundle branch area pacing (LBBAP) implantation is useful to evaluate lead depth. Technical aspects for recording COI amplitude have not been well studied. Our aims were to evaluate the impact of high-pass filter settings on electrogram recordings during LBBAP implantation. METHODS AND RESULTS: Consecutive patients with successful LBBAP implantation had unipolar recordings of COI at final lead position at different high-pass filter settings (0.01-1â Hz) from the tip electrode during sensing and pacing, and from the ring electrode during sensing. Duration of saturation-induced signal loss was also measured at each filter setting. COI amplitudes were compared between lumenless and stylet-driven leads. A total of 156 patients (96 males, aged 81.4 ± 9.6 years) were included. Higher filter settings led to significantly lower COI amplitudes. In 50 patients with COI amplitude < 10â mV, the magnitude of the drop was on average 1-1.5â mV (and up to 4â mV) between 0.05 and 0.5â Hz, meaning that cut-offs may not be used interchangeably. Saturation-induced signal loss was on average 10â s at 0.05â Hz and only 2â s with 0.5â Hz. When pacing was interrupted, the sensed COI amplitude varied (either higher or lower) by up to 4â mV, implying that it is advisable to periodically interrupt pacing to evaluate the sensed COI when reaching levels of â¼10â mV. Lead type did not impact COI amplitude. CONCLUSION: High-pass filters have a significant impact on electrogram characteristics at LBBAP implantation, with the 0.5â Hz settings having the most favourable profile.
Assuntos
Estimulação Cardíaca Artificial , Humanos , Masculino , Feminino , Idoso de 80 Anos ou mais , Idoso , Estimulação Cardíaca Artificial/métodos , Eletrodos Implantados , Técnicas Eletrofisiológicas Cardíacas , Fascículo Atrioventricular/fisiopatologia , Marca-Passo Artificial , Desenho de Equipamento , Resultado do Tratamento , Potenciais de AçãoRESUMO
AIMS: To characterize the diagnosis, frequency, and procedural implications of septal venous channel perforation during left bundle branch area pacing (LBBAP). METHODS AND RESULTS: All consecutive patients undergoing LBBAP over an 8-month period were prospectively studied. During lead placement, obligatory septal contrast injection was performed twice, at initiation (implant entry zone) and at completion (fixation zone). An intuitive fluoroscopic schema using orthogonal views (left anterior oblique/right anterior oblique) and familiar landmarks is described. Using this, we resolved zonal distribution (I-VI) of lead position on the ventricular septum and its angulation (post-fixation angle θ). Subjects with and without septal venous channel perforation were compared. Sixty-one patients {male 57.3%, median age [interquartile range (IQR)] 69.5 [62.5-74.5] years} were enrolled. Septal venous channel perforation was observed in eight (13.1%) patients [male 28.5%, median age (IQR) 64 (50-75) years]. They had higher frequency of (i) right-sided implant (25% vs. 1.9%, P = 0.04), (ii) fixation in zone III at the mid-superior septum (75% vs. 28.3%, P = 0.04), (iii) steeper angle of fixation-median θ (IQR) [19 (10-30)° vs. 5 (4-19)°, P = 0.01], and (iv) longer median penetrated-lead length (IQR) [13 (10-14.8) vs. 10 (8.5-12.5) mm, P = 0.03]. Coronary sinus drainage of contrast was noted in five (62.5%) patients. Abnormal impedance drops during implantation (12.5% vs. 5.7%, P = NS) were not significantly different. CONCLUSION: When evaluated systematically, septal venous channel perforation may be encountered commonly after LBBAP. The fiducial reference framework described using fluoroscopic imaging identified salient associated findings. This may be addressed with lead repositioning to a more inferior location and is not associated with adverse consequence acutely or in early follow-up.
Assuntos
Estimulação Cardíaca Artificial , Humanos , Masculino , Feminino , Estudos Prospectivos , Pessoa de Meia-Idade , Idoso , Estimulação Cardíaca Artificial/métodos , Septo Interventricular/diagnóstico por imagem , Traumatismos Cardíacos/etiologia , Traumatismos Cardíacos/diagnóstico por imagem , Resultado do Tratamento , Fatores de Risco , Fascículo Atrioventricular/fisiopatologia , Septos Cardíacos/diagnóstico por imagem , Meios de Contraste , Fluoroscopia , Bloqueio de Ramo/fisiopatologia , Bloqueio de Ramo/etiologiaRESUMO
INTRODUCTION: Left bundle branch area (LBBA) pacing (LBBAP) has been proposed as an alternative therapy option in patients indicated for cardiac pacing to treat bradycardia or heart failure. The aim of the study was to evaluate the safety and effectiveness of LBBAP in patients implanted with a Tendril 2088 stylet-driven lead. METHODS: The international retrospective data collection registry included 11 sites from 5 countries globally. Patients with attempted implants of the Tendril lead in the LBBA were followed for at least 6 months post the implant attempt. The primary safety and efficacy endpoints were freedom from LBBAP lead-related serious adverse events and the composite of LBBA capture threshold of ≤2.0 V and R-wave amplitudes ≥5 mV (or ≥value at implant), respectively. RESULTS: Of 221 patients with attempted implants of the Tendril 2088 lead in the LBBA, 91.4% (202/221) had successful implants for LBBAP. Regardless of the LBBAP implant success, all patients were followed for at least 6 months (8.7 ± 7.3 months). Baseline characteristics: 44% female, 84% ≥65 years old, 34% coronary artery disease, and 86% of primary indications for pacemaker implant. Both primary safety and effectiveness endpoints were met (freedom from LBBAP lead-related serious adverse device effects of 99.5% and electrical performance composite success rate of 93%). The capture thresholds in LBBAP at implant and 6 months were 0.8 ± 0.3 V@0.4 ± 0.1 ms and 0.8 ± 0.3 V@0.4 ± 0.1 ms. The rate of patients with capture threshold rise ≥1 V was 1.5% through 6 months. The R-wave amplitudes in LBBAP at implant and 6 months were 9.3 ± 3.2 mV and 10.6 ± 3.0 mV. CONCLUSIONS: This large multicenter study demonstrates that the stylet-driven Tendril™ STS 2088 lead is safe and effective for LBBAP with high success and low complication rates.
Assuntos
Potenciais de Ação , Estimulação Cardíaca Artificial , Frequência Cardíaca , Marca-Passo Artificial , Sistema de Registros , Humanos , Feminino , Masculino , Idoso , Estudos Retrospectivos , Fatores de Tempo , Pessoa de Meia-Idade , Resultado do Tratamento , Idoso de 80 Anos ou mais , Bradicardia/fisiopatologia , Bradicardia/terapia , Bradicardia/diagnóstico , Fascículo Atrioventricular/fisiopatologia , Insuficiência Cardíaca/fisiopatologia , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/terapia , Fatores de Risco , Desenho de EquipamentoAssuntos
Potenciais de Ação , Fascículo Atrioventricular , Ablação por Cateter , Técnicas Eletrofisiológicas Cardíacas , Frequência Cardíaca , Taquicardia Ventricular , Humanos , Taquicardia Ventricular/fisiopatologia , Taquicardia Ventricular/diagnóstico , Taquicardia Ventricular/cirurgia , Fascículo Atrioventricular/fisiopatologia , Masculino , Estimulação Cardíaca Artificial , Resultado do Tratamento , Eletrocardiografia , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Feminino , Fatores de TempoRESUMO
INTRODUCTION: Left bundle branch area pacing is an alternative to biventricular pacing. In this study, we aim to summarize the available evidence on the feasibility, efficacy, and safety of left bundle branch block area pacing (LBBAP). OBJECTIVES: The study summarizes the available evidence on the feasibility, efficacy, and safety of left bundle branch block area pacing (LBBAP). BACKGROUND: Cardiac resynchronization therapy (CRT) reduced mortality and hospitalizations in heart failure (HF) patients with a left ventricular ejection fraction (LVEF) ≤ 35% and concomitant LBBB. Recently LBBAP has been studied as a more physiological alternative to achieve CRT. METHOD: A search of PubMed, EMBASE, and Cochrane databases were performed to identify studies examining the role of LBBAP for CRT in heart failure. Comprehensive meta-analysis version 4 was used for meta-regression to examine variables that contribute to data heterogeneity. RESULT: Eighteen studies, 17 observational and one randomized controlled trial (RCT) were examined. A total of 3906 HF patients who underwent CRT (2036 LBBAP vs. 1870 biventricular pacing [BVP]) were included. LBBAP was performed successfully in 90.4% of patients. Compared to baseline, LBBAP was associated with a reduction in QRS duration (MD: -47.23 ms 95% confidence interval [CI]: -53.45, -41.01), an increase in LVEF (MD: 15.22%, 95% CI: 13.5, 16.94), and a reduction in NYHA class (MD: -1.23, 95% CI: -1.41, -1.05). Compared to BVP, LBBAP was associated with a significant reduction in QRS duration (MD: -20.69 ms, 95% CI: -25.49, -15.88) and improvement in LVEF (MD: 4.78%, 95% CI: 3.30, 6.10). Furthermore, LBBAP was associated with a significant reduction in HF hospitalization (odds ratio [OR]: 0.44, 95% CI: 0.34, 0.56) and all-cause mortality (OR: 0.67, 95% CI: 0.52, 0.86) compared to BVP. CONCLUSION: LBBAP was associated with improved ventricular electrical synchrony compared to BVP, as well as better echocardiographic and clinical outcomes.
Assuntos
Bloqueio de Ramo , Terapia de Ressincronização Cardíaca , Insuficiência Cardíaca , Função Ventricular Esquerda , Humanos , Insuficiência Cardíaca/fisiopatologia , Insuficiência Cardíaca/terapia , Insuficiência Cardíaca/mortalidade , Insuficiência Cardíaca/diagnóstico , Bloqueio de Ramo/fisiopatologia , Bloqueio de Ramo/terapia , Bloqueio de Ramo/diagnóstico , Bloqueio de Ramo/mortalidade , Resultado do Tratamento , Feminino , Masculino , Idoso , Terapia de Ressincronização Cardíaca/mortalidade , Terapia de Ressincronização Cardíaca/efeitos adversos , Fatores de Risco , Volume Sistólico , Fascículo Atrioventricular/fisiopatologia , Pessoa de Meia-Idade , Recuperação de Função Fisiológica , Fatores de Tempo , Frequência Cardíaca , Potenciais de AçãoAssuntos
Bradicardia , Estimulação Cardíaca Artificial , Ecocardiografia , Humanos , Bradicardia/terapia , Bradicardia/fisiopatologia , Bradicardia/diagnóstico , Masculino , Resultado do Tratamento , Feminino , Idoso , Fascículo Atrioventricular/fisiopatologia , Fascículo Atrioventricular/diagnóstico por imagem , Frequência Cardíaca , Pessoa de Meia-Idade , Radiografia Intervencionista , Valor Preditivo dos TestesAssuntos
Dispositivos de Terapia de Ressincronização Cardíaca , Terapia de Ressincronização Cardíaca , Desfibriladores Implantáveis , Remoção de Dispositivo , Humanos , Masculino , Idoso , Terapia de Ressincronização Cardíaca/métodos , Feminino , Remoção de Dispositivo/métodos , Pessoa de Meia-Idade , Resultado do Tratamento , Fascículo Atrioventricular/fisiopatologia , Reimplante/métodos , Vasos Coronários/cirurgia , Vasos Coronários/diagnóstico por imagem , Vasos Coronários/fisiopatologia , Insuficiência Cardíaca/terapia , Insuficiência Cardíaca/fisiopatologia , Cardioversão Elétrica/instrumentação , Estudos RetrospectivosAssuntos
Fascículo Atrioventricular , Terapia de Ressincronização Cardíaca , Insuficiência Cardíaca , Humanos , Terapia de Ressincronização Cardíaca/métodos , Insuficiência Cardíaca/terapia , Insuficiência Cardíaca/fisiopatologia , Fascículo Atrioventricular/fisiopatologia , Ventrículos do Coração/fisiopatologia , Estimulação Cardíaca Artificial/métodos , Resultado do Tratamento , Função Ventricular Direita , Bloqueio de Ramo/terapia , Bloqueio de Ramo/fisiopatologia , Bloqueio de Ramo/diagnóstico , Dispositivos de Terapia de Ressincronização CardíacaRESUMO
BACKGROUND: Atrioventricular block (AVB) is a frequent complication in patients undergoing transcatheter aortic valve implantation (TAVI). Right apex ventricular pacing (RVP) represents the standard treatment but may induce cardiomyopathy over the long term. Left bundle branch area pacing (LBBAP) is a promising alternative, minimizing the risk of desynchrony. However, available evidence with LBBAP after TAVI is still low. OBJECTIVE: To assess the feasibility and safety of LBBAP for AVB post-TAVI compared with RVP. METHODS: Consecutive patients developing AVB early after TAVI were enrolled between 1 January 2022 and 31 December 2022 at three high-volume hospitals and received LBBAP or RVP. Data on procedure and at short-term follow-up (at least 3âmonths) were collected. RESULTS: A total of 38 patients (61% men, mean age 83â±â6âyears) were included; 20 patients (53%) received LBBAP. Procedural success was obtained in all patients according to chosen pacing strategy. Electrical pacing performance at implant and after a mean follow-up of 4.2â±â2.8âmonths was clinically equivalent for both pacing modalities. In the LBBAP group, procedural time was longer (70â±â17 versus 58â±â15âmin in the RVP group, P â=â0.02) and paced QRS was shorter (120â±â19 versus 155â±â12âms at implant, P â<â0.001; 119â±â18 versus 157â±â9âms at follow-up, P â<â0.001). Complication rates did not differ between the two groups. CONCLUSION: In patients with AVB after TAVI, LBBAP is feasible and safe, resulting in a narrow QRS duration, either acutely and during the follow-up, compared with RVP. Further studies are needed to evaluate if LBBAP reduces pacing-induced cardiomyopathy in this clinical setting.
Assuntos
Estenose da Valva Aórtica , Bloqueio Atrioventricular , Fascículo Atrioventricular , Estimulação Cardíaca Artificial , Estudos de Viabilidade , Substituição da Valva Aórtica Transcateter , Humanos , Masculino , Estenose da Valva Aórtica/cirurgia , Estenose da Valva Aórtica/fisiopatologia , Substituição da Valva Aórtica Transcateter/efeitos adversos , Feminino , Idoso de 80 Anos ou mais , Idoso , Bloqueio Atrioventricular/etiologia , Bloqueio Atrioventricular/terapia , Bloqueio Atrioventricular/fisiopatologia , Bloqueio Atrioventricular/diagnóstico , Resultado do Tratamento , Estimulação Cardíaca Artificial/efeitos adversos , Estimulação Cardíaca Artificial/métodos , Fascículo Atrioventricular/fisiopatologia , Fatores de Tempo , Letônia , Fatores de Risco , Valva Aórtica/cirurgia , Valva Aórtica/fisiopatologia , Valva Aórtica/diagnóstico por imagem , Frequência CardíacaRESUMO
BACKGROUND: His bundle pacing (HBP) engaged electrical activation of both ventricles by stimulating the His-Purkinje network, which could avoid marked ventricles dyssynchrony. The lead was given three to five clockwise rotations at the site with the His potential to anchor the interventricular septum. In 2018, the Multicenter His Bundle Pacing Collaborative Working Group recommended that the His bundle capture threshold should be lower than 2.5 V/1 ms in non-pacing-dependent patients, and pacing-dependent patients should have a lower adjacent ventricular capture threshold as self-backup. Therefore, to avoid safety issues such as loss of capture caused by increased threshold, we believe that more stringent criteria should be adopted in patients with atrioventricular block (AVB). In previous studies, the connection cable needed to be disconnected during the screwing. When the procedure was finished, the performer found that the patients with His bundle injury could obtain a lower threshold than those without His bundle injury. Although no studies of new bundle branch block (BBB) or AVB by the acute His bundle injury was reported. However, It is worrying that the damage of His bundle seems random during the procedure. How to balance avoiding severe injury with a lower capture threshold? At present, we report a case of light His injury and lower His capture threshold under continuous intracardiac electrocardiogram monitoring.