A beginner's guide to permanent left bundle branch pacing

Huang, Weijian; Chen, Xueying; Su, Lan; Wu, Shengjie; Xue, Xiaonan; Vijayaraman, Pugazhendhi

doi:10.1016/j.hrthm.2019.06.016

Cited by 495 publications

(605 citation statements)

References 10 publications

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“…Detailed implant procedures have been described previously by Huang et al 14 His potential mapping combined with pace mapping was performed first in every patient. The location of His bundle would help certify the initial position of screwing.…”

Section: Methodsmentioning

confidence: 99%

Electrophysiological characteristics and clinical values of left bundle branch current of injury in left bundle branch pacing

Cai

et al. 2020

Cardiovasc electrophysiol

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Background Left bundle branch pacing (LBBP) is emerging as a novel option for physiological ventricular pacing. The impact of current of injury (COI) at left bundle branch (LBB) has not been previously evaluated. Methods Consecutive patients with QRS duration less than 120 milliseconds referred for LBBP in whom LBB potentials were recorded were included from August 2018 to March 2019. We recorded LBB COI during LBBP and assessed its impact on the pacing parameters and complications during implantation and at short term follow‐up. Results A total of 115 patients with an identifiable LBB potential at implant were included. LBB COI was confirmed in 77 (67.0%) of these patients. Three types of LBB COI were observed. LBB was captured in all patients at a pacing threshold less than 1.5 V/0.5 ms in COI(+) patients, while present in only 29 patients without an LBB COI(−) (100% vs 76.3%; P < .001). There was no significant difference between COI(+) and COI(−) patients in LBB bundle capture threshold (0.64 ± 0.24 vs 0.74 ± 0.26 V/0.5 ms). Selective LBBP was more common in COI(+) group than COI(−) group (54.5% vs 0%; P < .001). Pacing parameters were stable and no lead perforation or dislodgements were observed during follow‐up. Conclusions LBB COI is commonly observed during LBBP in cases with an identifiable LBB potential and can be associated with a low LBB capture threshold and demonstrable selective capture of the LBB acutely and during follow‐up. A COI does not preclude safe and stable LBBP pacing.

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Section: Methodsmentioning

confidence: 99%

Electrophysiological characteristics and clinical values of left bundle branch current of injury in left bundle branch pacing

Cai

et al. 2020

Cardiovasc electrophysiol

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“…After crossing the tricuspid annulus, the pacing lead was advanced toward the ventricular apex for 1.5‐2 cm beyond the site where the His bundle potential was recorded under fluoroscopic guidance in the right anterior oblique (RAO; 30°) projection. Based on previously reported experience, 8 the site where the paced QRS complex presented a ‘W’ pattern in lead V 1 was selected as the initial implantation site of the pacing lead. Subsequently, the 3830 lead was screwed in place towards the left side of the interventricular septum (IVS).…”

Section: Methodsmentioning

confidence: 99%

Electrocardiographic morphology during left bundle branch area pacing: Characteristics, underlying mechanisms, and clinical implications

Gao

Tian

Shi

et al. 2020

Pacing Clinical Electrophis

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Aims In this study, we investigated the characteristics and underlying mechanisms of the electrocardiographic (ECG) morphology during left bundle branch area pacing (LBBAP), which have not been systematically described. Methods Patients with indications for permanent cardiac pacing underwent LBBAP attempts. The ECGs of patients with confirmed left bundle branch (LBB) capture were compared with those of individuals with right bundle branch block (RBBB) on 12‐lead ECG. Intracardiac electrograms recorded during implantation were analyzed in all patients who underwent pacing. Results LBBAP was successfully achieved in 87.5% (56/64) of patients. The QRS morphologies in lead V1 during LBBAP, which typically demonstrated Qr (60.7%), qR (19.6%), rSR’ (7.1%), or QS (12.5%) patterns, differed from those of native RBBB, which featured rsR’ (57.5%), M shape (23.7%), or monophasic R patterns (18.7%). The terminal R' wave duration in lead V1 was significantly shorter during LBBAP than during native RBBB (51 ± 12 ms vs 85 ± 19 ms, p < 0.001). LBB potentials were recorded in 66.1% (37/56) of the LBBAP patients. No significant differences in ECG characteristics were found between LBBAP with and without recorded LBB potentials. The presence of bundle branch block during LBBAP significantly prolonged QRS duration, R wave peak time, and terminal R’ wave duration in lead V1. Conclusion LBBAP‐ECG patterns are characterized by a shorter terminal R’ wave duration in lead V1 compared with that of native RBBB configurations. Bundle branch conduction integrity has an impact on ECG characteristics during LBBAP.

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“…The methodology for LBBP has previously been described in detail . Briefly, right ventricular septal location for LBBP is identified using both the fluoroscopic location of the distal His bundle and the right ventricular paced QRS morphology.…”

Section: Three‐dimensional (3d) Mappingmentioning

confidence: 99%

Left bundle branch pacing utilizing three dimensional mapping

Vijayaraman

Panikkath

Mascarenhas

et al. 2019

Cardiovasc electrophysiol

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Introduction Permanent His bundle pacing is feasible and effective in patients with atrioventricular block or left bundle branch block. However, pacing thresholds to capture the distal His bundle is often higher. Recently left bundle branch area pacing (LBBP) has been shown to be feasible by advancing the lead transvenously, deep into the interventricular septum to reach the left ventricular endocardial surface. In this article we describe the utility of three dimensional (3D) mapping to achieve LBBP. Methods Ensite Precision (Abbott) mapping system was used to perform LBBP. A decapolar catheter was used to create 3D map of right atrium and right ventricle (RV). Regions of interest (His bundle, potential LBBP sites of interest in RV) were tagged in the 3D map. The LBBP lead was implanted utilizing the 3D map. The lead depth in the septum was assessed in the 3D map. Results LBBP was performed in three patients: chronic LBBB and intermittent 2:1 atrioventricular block; atrioventricular (AV) node ablation and conduction system pacing; and bifascicular block and intermittent AV block in a patient with severe left ventricular hypertrophy. LBBP was successful in all three patients. The lead depth in the interventricular septum was 12, 11, and 21 mm, respectively as assessed by 3D mapping. Conclusions Three‐dimensional mapping was helpful in achieving LBBP in patients with LBBB, severe left ventricular hypertrophy or during AV node ablation. 3D mapping also facilitated easy assessment of lead depth during and after lead fixation. 3D mapping techniques may be a valuable tool to reduce the learning curve of implanters with minimal experience in LBBP.

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A beginner's guide to permanent left bundle branch pacing

Cited by 495 publications

References 10 publications

Electrophysiological characteristics and clinical values of left bundle branch current of injury in left bundle branch pacing

Electrophysiological characteristics and clinical values of left bundle branch current of injury in left bundle branch pacing

Electrocardiographic morphology during left bundle branch area pacing: Characteristics, underlying mechanisms, and clinical implications

Left bundle branch pacing utilizing three dimensional mapping

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