AI Article Synopsis
- Researchers explored how septal scar tissue affects the success of left bundle branch area pacing (LBBAP) in patients needing bradycardia pacing or cardiac resynchronization therapy.
- They conducted a study with 35 patients who had preprocedural assessments using cardiac MRI to evaluate scar extent before attempting lead implantation.
- Results showed that successful lead deployment was more likely in patients with less septal scar, indicating that extensive scar tissue may hinder the implantation process and suggesting possible alternative strategies for those patients.
Article Abstract
Background: The use of left bundle branch area pacing (LBBAP) for bradycardia pacing and cardiac resynchronization is increasing, but implants are not always successful. We prospectively studied consecutive patients to determine whether septal scar contributes to implant failure.
Methods: Patients scheduled for bradycardia pacing or cardiac resynchronization therapy were prospectively enrolled. Recruited patients underwent preprocedural scar assessment by cardiac MRI with late gadolinium enhancement imaging. LBBAP was attempted using a lumenless lead (Medtronic 3830) via a transeptal approach.
Results: Thirty-five patients were recruited: 29 male, mean age 68 years, 10 ischemic, and 16 non-ischemic cardiomyopathy. Pacing indication was bradycardia in 26% and cardiac resynchronization in 74%. The lead was successfully deployed to the left ventricular septum in 30/35 (86%) and unsuccessful in the remaining 5/35 (14%). Septal late gadolinium enhancement was significantly less extensive in patients where left septal lead deployment was successful, compared those where it was unsuccessful (median 8%, IQR 2%-18% vs. median 54%, IQR 53%-57%, p < .001).
Conclusions: The presence of septal scar appears to make it more challenging to deploy a lead to the left ventricular septum via the transeptal route. Additional implant tools or alternative approaches may be required in patients with extensive septal scar.
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| http://dx.doi.org/10.1111/pace.14804 | DOI Listing |
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