Pacemaker lead placement innovation comes to King's Daughters
Electrophysiologist Kristin Ellison, M.D., recently performed a first for our region - a His-bundle pacing procedure. The procedure is a relatively new way to correct electrical impulses in the heart. During the procedure, Dr. Ellison implants a pacemaker as normal. The innovation is where the lead - the pacemaker’s electrical wire that stimulates the heart - is placed.
Pacing the heart from the His-bundle allows the heart to be activated by its normal electrical conduction pathway. “Our goal is to pace the electrical system and utilizing the heart’s own wiring track to activate the heart muscle,” Dr. Ellison said. “pacing at the His-bundle allows the signal to go down these specialized wiring tracks in the middle of the heart and quickly out to the entire heart. In general, Mother Nature does it best. We’re using the system that’s already there.”
Clinical studies have shown His-bundle pacing can overcome blocks further down the heart’s conduction system, such as right and left bundle branch block. It is also being evaluated as an alternative to biventricular pacing.
Most pacemakers activate the ventricle with a lead or wire placed within the right ventricular area. The pacemaker’s lead is placed on the right ventricle, and if needed, the right atrium as well. When the heart is activated through the muscle in the right ventricle, activation is slower and spreads from right to left. The left side of the heart is activated much later than the right, which can create dyssynchrony, or a slight wobble in the heart. This has been shown to weaken some hearts over time. The more you pace the right ventricle and the weaker the heart strength is to begin with, the greater the probability of heart muscle weakening.
Dr. Ellison says there are two factors that make patients good candidates for His-bundle pacing. The first is the amount of electrical pacing required. The more it’s required, the more likely a patient could benefit from His-bundle pacing. The second factor is the heart’s pump strength. The less pump strength the heart displays, the greater importance of avoiding dyssynchrony or wobble that can further weaken the heart.
Dr. Ellison sees patients in Louisa and Prestonsburg, Ky. She performs procedures at the King’s Daughters main campus in Ashland. You can reach her in Louisa at (606) 638-9954; in Prestonsburg, call (606) 886-0892. She recently joined the electrophysiology team at King’s Daughters, which also includes Ola Khraisha, M.D.; Terence Ross, M.D.; and John Van Deren, M.D.
