A Balloon Tipped Catheter for Obtaining His Bundle Electrograms Without Fluoroscopy

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Abstract
A technique for recording His bundle activity in man without fluoroscopic guidance is described. Balloon tipped tri- or tetrapolar catheters were designed with pacing electrodes located at the catheter tip, and two fine sensing electrodes 4 and 5 cm behind it. The catheter tip was preformed into a "J" curve. Following percutaneous transfemoral insertion, the catheter is floated to the right ventricle under electrocardiographic control. This tip configuration and the transfemoral route of insertion typically directs the catheter into an inverted "J" position with its tip in or near the right ventricular apex. Subsequent catheter withdrawal carries the sensing electrodes through the superior portion of the tricuspid valve and permits recording from the His bundle. With this technique His bundle recordings were possible in 23 of 24 patients. Re-advancement into the right ventricular apex permits stable temporary pacing.