Conduction system pacing in difficult cardiac anatomies: Systematic approach with the 3D electroanatomic mapping guide

Marcantoni, Lina; Centioni, Marco; Pastore, Gianni; Aneris, Federico; Baracca, Enrico; Zanon, Francesco

doi:10.1016/j.ipej.2023.08.006

Cited by 1 publication

(1 citation statement)

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“…Previous case reports and an observational study using the same 3D mapping system have been published on electro-anatomically guided CSP with overall good results, but still with long fluoroscopy times, contradicting the original idea of a low fluoroscopy procedure [9,10]. In another prospective study that included 32 patients with advanced conduction abnormalities and structural heart disease, electro-anatomically guided LBBAP was achieved in 91% of the patients with a mean fluoroscopy time of 0.93 min.…”

Section: Discussionmentioning

confidence: 89%

Optimal Cardiac Resynchronization Therapy with Conduction System Pacing Guided by Electro-Anatomical Mapping: A Case Report

Pestrea,

Enache,

Cicala

et al. 2023

JCDD

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Introduction: Biventricular pacing has been the gold standard for cardiac resynchronization therapy in patients with left bundle branch block and severely reduced left ventricular ejection fraction for decades. However, in the past few years, this role has been challenged by the promising results of conduction system pacing in these patients, which has proven non-inferior and, at times, superior to biventricular pacing regarding left ventricular function outcomes. One of the most important limitations of both procedures is the long fluoroscopy times. Case description: We present the case of a 60-year-old patient with non-ischemic dilated cardiomyopathy and left bundle branch block in whom conduction system pacing was chosen as the first option for resynchronization therapy. A 3D electro-anatomical mapping system was used to guide the lead to the His bundle region, where correction was observed at high amplitudes, and afterward to the optimal septal penetration site. After reaching the left endocardium, left bundle branch pacing achieved a narrow, paced QRS complex with low fluoroscopy exposure. The three-month follow-up showed a significant improvement in clinical status and left ventricular function. Conclusion: Since conduction system pacing requires a great deal of precision, targeting specific, narrow structures inside the heart, 3D mapping is a valuable tool that increases the chances of success, especially in patients with complex anatomies, such as those with indications for cardiac resynchronization therapy.

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Section: Discussionmentioning

confidence: 89%