Background: Left bundle branch (LBB) pacing (P) has gained rapid adoption. Evidence for direct LBB capture has varied from 30-95% depending on the criteria.
Objective: The aim of the study was to assess the feasibility and efficacy of intraprocedural transthoracic echo guidance to achieve LBB capture.
Methods: This was a prospective, nonrandomized, case-control study (NCT05646251). The pectoral region including echocardiographic windows were sterile-draped using Ioban. The lead was placed in the RV septum and sheath orientation adjusted under echo. The lead was advanced under echo visualization until the tip reaches the LV subendocardium. LBB capture was strictly defined: Transition from nonselective to selective/LV septal capture; LBB potential with injury current; Delta (HBP-LBBP) V6RWPT of ≥10.
Results: Thirty patients underwent Echocardiography guided (EC)-LBBP and compared with 30 patients (standard approach). Mean age 74.4±10; female 45%; hypertension 92%; cardiomyopathy 43%; AV block/AV node ablation 75%. Total procedural and fluoroscopy duration were similar. Left bundle branch area pacing (LBBP or LV septal pacing) was successful in all patients in both groups. EC-LBBP was 97% successful in achieving LBB capture (vs 70%, P=0.02) with LBB potentials (LB-V 23±6ms) in 95% (vs 77%, 22±6ms). Morphology transition confirming LBB capture was seen in 87% vs 67% (P=0.02). Lead-tip was visualized at LV subendocardium in 100% of patients in EC-LBBP.
Conclusions: EC-LBBP was 97% successful in achieving LBB capture using strict criteria. LBBP lead was subendocardial in all patients. EC-LBBP is practical, feasible, safe and highly effective in achieving LBB capture.
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| http://dx.doi.org/10.1016/j.hrthm.2024.12.039 | DOI Listing |
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Background: Left bundle branch (LBB) pacing (P) has gained rapid adoption. Evidence for direct LBB capture has varied from 30-95% depending on the criteria.
Objective: The aim of the study was to assess the feasibility and efficacy of intraprocedural transthoracic echo guidance to achieve LBB capture.
LOCAlizaTion and clinical corrElation of Left Bundle Branch Pacing lead: Insights from a computed tomographic angiography (LOCATE LBBP) study.
Heart Rhythm
November 2024
Geisinger Heart Institute, Geisinger Commonwealth School of Medicine, Wilkes Barre, Pennsylvania.
Background: Left bundle branch pacing (LBBP) provides physiological activation with stable pacing parameters. However, there is a paucity of data on direct assessment of lead stability.
Objectives: The purpose of this study was to assess the stability of an LBBP lead using computed tomographic angiography (CTA) during medium-term follow-up and to correlate the anatomic location of the lead and electrophysiological characteristics of LBBP.
Predictors of success in left bundle branch area pacing with stylet-driven pacing leads: a multicenter investigation.
Front Cardiovasc Med
September 2024
Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
Article Synopsis
- This study looked at how to successfully use a new heart procedure called left bundle branch area pacing (LBBAP) and what makes it work better.
- They tried this procedure on 119 patients, mostly with heart problems, and found out it worked well in most cases.
- They discovered that fewer attempts to put in the heart leads meant better success, and that certain heart conditions, like intraventricular conduction delay (IVCD) and a larger heart part called the right atrium, made the procedure harder.
Six transition patterns and seven capture types in different left bundle branch bipolar pacing configurations.
Front Cardiovasc Med
September 2024
Department of Cardiology, Ningbo No. 2 Hospital, Ningbo Cardiovascular Center, Ningbo, Zhejiang, China.
Aims: This study aims to explore the different transition patterns and capture types during two bipolar pacing tests based on the selective left bundle branch (LBB) capture determined by the continuous pacing and recording technique.
Methods: In total, 67 patients completed two unipolar and two bipolar pacing tests based on selective LBB capture during screwing-in for left bundle branch pacing (LBBP) using the continuous pacing and recording technique. The electrophysiological characteristics and potential mechanisms of different pacing configurations were further evaluated in this study.
Durability of output-dependent QRS transition and left bundle branch capture in left bundle branch area pacing.
Heart Rhythm
August 2024
Department of Cardiovascular Medicine, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan.
Background: Although output-dependent QRS transition is a specific indicator that confirms left bundle branch (LBB) capture during left bundle branch area pacing (LBBAP), its durability remains unclear.
Objective: The purpose of this study was to evaluate the presence of output-dependent QRS transition and capture thresholds of the LBB and left ventricular septal myocardium immediately and up to 1 year after the LBBAP procedure.
Methods: We enrolled 129 patients with successful LBBAP who were available for 1-year follow-up postoperatively.
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