Feasibility of His bundle pacing facilitated by EASI derived 12-lead ECG

Introduction: His bundle pacing (HBP) has become popular in recent years as a more physiological alternative to conventional right ventricular pacing. Implantation requires 12-lead ECG during surgery, which is not readily available in a standard operating room. Often but not always HBP is performed in an electrophysiology lab. EASI is a reduced lead system which enables derived 12-lead ECG. EASI derived 12-lead ECGs on modern tablet computers offer a more mobile and lightweight ECG solution which does not obstruct fluoroscopy during implantation. This case series aims to compare standard 12-lead ECG to EASI derived 12-lead ECG in patients undergoing HBP implantation. Methods and results: A total of 11 patients received permanent HBP guided only by fluoroscopy, a pacing system analyzer (Medtronic CareLink SmartSync Device Manager) and EASI derived 12-lead ECG (CardioSecur Pro). During the first postoperative device interrogation HBP criteria, as defined in the EHRA consensus paper on conduction system pacing, were evaluated with the EASI derived system as well as a standard 12-lead ECG and compared to each other. There was perfect agreement with regards to these criteria which lead to identical conclusions in all cases. Conclusion: HBP implantation can be performed with EASI derived 12-lead ECG instead of conventional 12-lead ECG. Criteria for discriminating between selective His bundle, non-selective His bundle or myocardial capture alone are clearly visible in the EASI derived ECG leading to the same conclusion when compared to standard 12-lead ECG. Compared to a conventional 12-lead ECG the EASI system offers a leaner setup with less visual obstruction on fluoroscopy.