B-po03-060 the effect of his bundle pacing lead thresholds at implant on long term lead performance

His bundle pacing (HBP) is a form of conduction system pacing with left bundle branch pacing emerging as an alternative. It is unclear if higher HBP lead thresholds at implant are associated with increased lead related complications in long term follow up. We sought to evaluate if a new strategy of accepting HBP if the lead threshold is < 1.5 V @ 1 ms at implant was associated with better long term HBP lead related outcomes. Pacemaker or CRT devices with HBP leads implanted between 08/01/2016 to 03/01/2020 at our center were included. Prior to 06/2018 we accepted HBP lead threshold < 1.5 V and up to 2.5V @ 1ms (Strategy 1) at implant. Subsequently, we only accepted HBP if the threshold at implant was < 1.5V @ 1ms (including bundle branch block (BBB) recruitment)(Strategy 2) (Figure). The two strategies were compared in lead performance. A total of 254 patients underwent HBP of which 240 patients were included in the analysis. A 134 patients underwent implant using strategy 1 while 106 patients underwent implant using strategy 2. The mean age was 70 ± 14 years. The average follow up was 2.4 ± 1.2 years (strategy 1) and 1.5 ± 0.7 years (strategy 2). There was a non significant trend towards a lower incidence of rise in HBP threshold by ≥ 1 V @ 1ms using Strategy 2 (17.2% vs 13.2%, p = 0.399). Lead revisions (4.5% vs 3.8%, p = 0.786) and HBP threshold ≥ 2.5 V @ 1ms in follow-up (16.4% vs 9.4%, p = 0.114) demonstrated a similar trend without statistical differences. A subgroup analysis of patients with and without BBB revealed similar findings. Implant HBP lead thresholds < 1.5 V @ 1ms demonstrated a non-significant trend towards improved lead performance during long-term follow up.