Left Bundle Branch Area Pacing for Cardiac Resynchronization Therapy

Vijayaraman, Pugazhendhi; Ponnusamy, Shunmuga Sundaram; Cano, Óscar; Sharma, Parikshit S.; Naperkowski, Angela; Subsposh, Faiz A.; Moskal, P.; Bednarek, Agnieszka; Forno, Alexander R. Dal; Young, W. Glenn; Nanda, Sudip; Beer, Dominik; Herweg, Bengt; Jastrzębski, Marek

doi:10.1016/j.jacep.2020.08.015

Cited by 230 publications

(228 citation statements)

References 25 publications

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“…A largest retrospective multicenter study by Vijayaraman et al 31 assessed the feasibility and outcomes of LBBP in CRT eligible patients. CRT could be successfully achieved by LBBP in 277 out of 325 attempted patients (85% success rate), which included 44% of ischemic cardiomyopathy patients.…”

Section: Clinical Implications Of Lbbpmentioning

confidence: 99%

Left bundle branch pacing: A comprehensive review

Ponnusamy

Arora

Namboodiri

et al. 2020

Cardiovasc electrophysiol

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Cardiac pacing is the only effective therapy for patients with symptomatic bradyarrhythmia. Traditional right ventricular apical pacing causes electrical and mechanical dyssynchrony resulting in left ventricular dysfunction, recurrent heart failure, and atrial arrhythmias. Physiological pacing activates the normal cardiac conduction, thereby providing synchronized contraction of ventricles. Though His bundle pacing (HBP) acts as an ideal physiological pacing modality, it is technically challenging and associated with troubleshooting issues during follow‐up. Left bundle branch pacing (LBBP) has been suggested as an effective alternative to overcome the limitations of HBP as it provides low and stable pacing threshold, lead stability, and correction of distal conduction system disease. This paper will focus on the implantation technique, troubleshooting, clinical implications, and a review of published literature of LBBP.

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Section: Clinical Implications Of Lbbpmentioning

confidence: 99%

Left bundle branch pacing: A comprehensive review

Ponnusamy

Arora

Namboodiri

et al. 2020

Cardiovasc electrophysiol

Self Cite

141

134

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“…In the results from the International LBBAP Collaborative Study Group, permanent LBBAP (including DSPs that meet electrical standards) was achieved in 277 of 325 patients (85%) and was unsuccessful in 48 patients because of inability to penetrate the septum (21 patients) and inadequate electric resynchronization (27 patients, including DSPs that do not meet electrical standards). 6 In another LBBAP study of feasibility assessment, permanent LBBAP was successful in 93 (93%) out of 100 patients while in five patients, the lead tip could not be placed in the LV septum and in the other two patients with cardiomyopathy, LBBAP failed to achieve significant narrowing of QRS width. 4 Whereas there have been some cases of LVSP or DSP with encouraging clinical outcomes.…”

Section: Discussionmentioning

confidence: 98%

“…However, for patients with heart failure and significantly enlarged heart, the success rate is affected significantly according to research reports. [4][5][6] Most studies have shown that operators used imaging technique and electrical parameters to locate the position and depth of the pacing lead model 3830 and to make sure the stability of the lead parameters through follow-up. 3,7,8 For example, sheath angiography or nine-partition method 9 was utilized to determine the initial lead tip location and test the pacing impedance, and capture threshold was used to check if there was a lead perforation.…”

Section: Introductionmentioning

confidence: 99%

Anatomical and histological assessment of left bundle branch area pacing in human heart with refractory heart failure

et al. 2022

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As an emerging pacing technique, left bundle branch area pacing (LBBAP) has served as a physiological pacing modality that overcomes the limitations of His bundle pacing (HBP) or right ventricular pacing. Three patients with terminal heart failure who were waiting for heart transplantation and met the indications of pacemaker implantations received LBBAP. Symptoms were relieved and stabilized and eventually received heart transplantation. Diseased hearts from the recipients were dissected post-transplantation, and the direct visual of pacing lead locations in the interventricular septum were evaluated, and the histopathological examination around the lead was conducted for the first time in human. As a result, we found that the locations of LBBAP leads were matched with fluoroscopic views during the procedure and Masson's staining showed extensive fibrosis occur around the lead but did not result in high thresholds.

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“…Since 2018, HBP is indicated in the American Guidelines 1 as an alternative to biventricular CRT in patients with AV block and left ventricular (LV) dysfunction. The His‐Sync randomized study showed that HBP is comparable to biventricular CRT in echocardiographic and electrocardiographic response achieved 2 and non‐randomized studies support LBBP as an alternative to biventricular CRT 3–6 . Wu et al 7 .…”

Section: Introductionmentioning

confidence: 99%

Septal flash correction with His‐Purkinje pacing predicts echocardiographic response in resynchronization therapy

Pujol‐López

Arjona

Guasch

et al. 2022

Pacing Clinical Electrophis

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Background: His-Purkinje conduction system pacing (HPCSP) has been proposed as an alternative to Cardiac Resynchronization Therapy (CRT); however, predictors of echocardiographic response have not been described in this population. Septal flash (SF), a fast contraction and relaxation of the septum, is a marker of intraventricular dyssynchrony. Methods:The study aimed to analyze whether HPCSP corrects SF in patients with CRT indication, and if correction of SF predicts echocardiographic response. This retrospective analysis of prospectively collected data included 30 patients. Left ventricular ejection fraction (LVEF) was measured with echocardiography at baseline and at 6-month follow-up. Echocardiographic response was defined as increase in five points in LVEF.Results: HPCSP shortened QRS duration by 48 ± 21 ms and SF was significantly decreased (baseline 3.6 ± 2.2 mm vs. HPCSP 1.5 ± 1.5 mm p < .0001). At 6-month follow-up, mean LVEF improvement was 8.6% ± 8.7% and 64% of patients were responders. There was a significant correlation between SF correction and increased LVEF (r = .61, p = .004). A correction of ≥1.5 mm (baseline SF -paced SF) had a sensitivity of 81% and 80% specificity to predict echocardiographic response (area under the curve 0.856, p = .019). Conclusion: HPCSP improves intraventricular dyssynchrony and results in 64%echocardiographic responders at 6-month follow-up. Dyssynchrony improvement with SF correction may predict echocardiographic response at 6-month follow-up.

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Left Bundle Branch Area Pacing for Cardiac Resynchronization Therapy

Cited by 230 publications

References 25 publications

Left bundle branch pacing: A comprehensive review

Left bundle branch pacing: A comprehensive review

Anatomical and histological assessment of left bundle branch area pacing in human heart with refractory heart failure

Septal flash correction with His‐Purkinje pacing predicts echocardiographic response in resynchronization therapy

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