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Bypassing the electrical wiring of the heart – physiological pacing

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December 2, 2020 0 2 minutes, 38 seconds read
Dr. Vanita Arora
Director and Head Cardiac Electrophysiology Lab & Arrhythmia Services Max Saket
Cardiac Sciences, Cardiology

The blockages in the arteries supplying blood to the heart require bypass surgery by putting grafts beyond the blockages and bypassing the blood to flow directly to the heart. So when there are blockages in the electrical wiring (heart beat) of the heart we have been using an inverter till date but what if  we were to do the bypass of the blocked wiring and pace by putting lead beyond the blockage and bypass the electrical current directly to the heart. This is possible by physiological pacing which is the electrical bypass.

Pacemaker is small device with a computer chip, with built-in power source in form of batteries that is one fourth the size of closed fist. This battery powered device sends electric energy via 1 or 2 wires called leads which is placed inside the right upper (atrial) or right lower (ventricle) chambers of the heart. Conventionally it monitors the electrical activity in the heart and works as invertor. Its starts sending electric impulse whenever the heart rate of person goes below the normal programmed rate.

The cardiologist till date have been using pacemaker as the invertor by placing the lead in the right ventricular apex region. This directly activates the heart muscle. Studies have shown that prolonged duration of pacing of the heart muscles through this mode can lead to weakening of the heart muscle leading to “heart failure”. On the contrary this can be prevented if the natural electrical wires of the heart or the conduction system (His Bundle or Bundle Branch fibers) are activated by placing the lead in these target areas, it would result in mimicking the natural mechanism of pacing the heart and lead to electrical bypass.

Hence Cardiac Electrophysiologist (EP’s) do physiological pacing now which is not using pacemaker as invertor but restoring normal electrical circuitry of the heart.

Since pacing in humans in 1962 was a breakthrough, it was always recognized that pacing from the right ventricular apex (lower chamber/ bottom part of the heart), was not natural physiologic way to pace but was reliable. Hence, reliance on the Pacemakers were synonymously referred to as artificial and were not representative of typical physiologic conduction. Early researchers were not oblivious of this fact and since then it has been a constant endeavor of EP’s to pace the natural conduction system – a goal unachievable for many years due to dearth of technological knowhow.

However, as years passed by and potential adverse effects of conventional non-physiologic Right Ventricular apical pacing began to emerge, it had an accelerating effect on innovation. Newer concept is pacing at a specific site of Heart called “His bundle” as against conventional right ventricle pacing became a reality. His Bundle Placement (a specialized electrical fiber which is somewhat centrally located in the region partitioning the heart chambers) which would provide physiological/natural way of electrical energy delivery. “HIS Bundle (physiological) pacing” is a novel method to re-engage the heart's natural electrical pathways instead of going around them, which could mean comparatively effective treatment options for patients suffering from electrical disturbances or heart failure patients.

It is performed with additional tools and the technique which is associated with a learning curve. 

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