{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,6]],"date-time":"2026-06-06T14:49:40Z","timestamp":1780757380465,"version":"3.54.1"},"reference-count":23,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2021,9,20]],"date-time":"2021-09-20T00:00:00Z","timestamp":1632096000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pacing Clinical Electrophis"],"published-print":{"date-parts":[[2021,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Permanent His\u2010bundle pacing (HBP) is effective and safe; however, the success rate of HBP is low, especially in patients with infranodal block. This study aimed to assess the efficacy and feasibility of HBP implantation using an electrophysiological guided approach targeting a distal His\u2010bundle electrogram (HBE) in patients with atrioventricular block (AVB).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Thirty\u2010four consecutive patients with AVB (infranodal block in 28 patients) who underwent HBP were enrolled. During implantation, we attempted to target the distal part of the HBE (distal HBE) beyond the block site based on unipolar mapping. The His\u2010capture threshold was evaluated for 1 year after implantation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>HBP was achieved in 26 patients and in 21 patients (75%) with infranodal block. Detection of distal HBE was significantly higher in the successful HBP group than in the HBP failure group (65.4%\u00a0vs. 0%, <jats:italic>p<\/jats:italic>\u00a0=\u00a0.001). Among 15 patients with intra\u2010Hisian block, 14 patients (93%) successfully achieved HBP with distal HBE detection. During the 1\u2010year follow\u2010up period, an increase in His\u2010capture threshold by \u22651.0 V at 1.0\u00a0ms occurred in five (19.2%) of 26 patients. The increased His\u2010capture threshold group exhibited significantly less detection of distal HBE (20%\u00a0vs. 76.2%; odds ratio 0.078, 95% confidence interval 0.07\u20130.87, <jats:italic>p<\/jats:italic>\u00a0=\u00a0.038) and a higher His\u2010capture threshold at implantation (2.0 \u00b1 1.1 V vs. 1.1 \u00b1 0.9 V; odds ratio 1.702, 95% confidence interval 1.025\u20132.825, <jats:italic>p<\/jats:italic>\u00a0=\u00a00.04) than the non\u2010increased His\u2010capture threshold group.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>HBP implantation guided by distal HBE approach may be feasible with subsequent stable pacing in patients with intra\u2010Hisian and atrioventricular nodal block.<\/jats:p><\/jats:sec>","DOI":"10.1111\/pace.14363","type":"journal-article","created":{"date-parts":[[2021,9,14]],"date-time":"2021-09-14T15:49:35Z","timestamp":1631634575000},"page":"1907-1917","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Permanent His\u2010bundle pacing using distal His\u2010bundle electrogram\u2010guided approach in patients with atrioventricular block"],"prefix":"10.1111","volume":"44","author":[{"given":"Kazumasa","family":"Suga","sequence":"first","affiliation":[{"name":"Division of Cardiology Japan Community Healthcare Organization Chukyo Hospital  Nagoya Japan"},{"name":"Department of Cardiology Nagoya University Graduate School of Medicine  Nagoya Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroyuki","family":"Kato","sequence":"additional","affiliation":[{"name":"Division of Cardiology Japan Community Healthcare Organization Chukyo Hospital  Nagoya 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