Contrast-enhanced image-guided lead deployment for left bundle branch pacing

Liu, Xi; Niu, Hongxia; Gu, Min; Chen, Xuhua; Hu, Yiran; Cai, Mengxin; Zhang, Nixiao; Zhao, Jiying; Zhou, Xiaohong; Gold, Michael R.; Hua, Wei; Zhang, Shu

doi:10.1016/j.hrthm.2021.04.015

Cited by 34 publications

(35 citation statements)

References 13 publications

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“…Jiang H et al [7] put forward the novel nine-partition method and concluded that most of the successful LBBP sites were distributed in the junction area of the second and the fifth partitions of the IVS; however, such a partition method is not a precise way to localize the lead yet, besides the study did not compare the discrepancy in spatial distribution between successful and failed sites while not quantitatively analyzing the relationship between the site distribution and the LBBP success probability. Recently, the TVA-image-guided method was published and regarded as a more visualized way to deploy the lead, whereas the study designated a fanshaped targeted area merely based on 20 successful LBBP sites without reporting the distribution of failed sites that might also locate in this area [8].…”

Section: Discussionmentioning

confidence: 99%

“…However, unlike HBP mapping the His bundle potential as the targeted site, left bundle branch (LBB) potential cannot be mapped from the right ventricular septum as the targeted site so that the lead localization of LBBP remains challenging. Several approaches have been published for LBBP implantation, such as mapping the His bundle potential [6], the novel nine-partition method [7], and the contrast-enhanced tricuspid valve annulus (TVA) imaging method [8], which qualitatively depend on visual estimations. Besides, several electrocardiographic (ECG) parameters [9], such as paced QRS duration (QRSd), QRS morphology, and QRS direction in limb leads during lead localization pacing, are empirical guides for lead-implanted site selection of LBBP but have never been confirmed by data.…”

Section: Introductionmentioning

confidence: 99%

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Quantitative distance and electrocardiographic parameters for lead-implanted site selection to enhance the success likelihood of left bundle branch pacing

Lin

Chen

et al. 2021

Clin Res Cardiol

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Background Left bundle branch pacing (LBBP) is a novel near-physiological pacing method that still lacks quantitative criteria to guide the selection of lead-implanted sites to enhance the success likelihood of lead deployments. This study aimed to quantitatively analyze the relationships of LBBP success likelihood to the distribution of lead-implanted sites and the lead-localization-pacing electrocardiographic (ECG) features. Methods All the lead-implanted sites in patients with finally successful LBBP were enrolled for analysis, including successful and failed sites. A novel coordinate system was invented to describe the sites' distribution as longitudinal distance (longit-dist) and lateral distance (lat-dist). Corrected distance parameters were generated to eliminate the cardiac dimension variations. The lead-localization-pacing ECG parameters were also collected, such as paced QRS duration (locat-QRSd), left ventricular activation time (locat-LVAT), LVAT/QRSd ratio (locat-LVAT/QRSd), and QRS directions. Results A total of 94 patients with 105 successful sites and 93 failed sites were enrolled. Longit-dist and corrected longitdist of successful sites were significantly longer, while locat-QRSd and locat-LVAT were shorter and locat-LVAT/QRSd was lower than failed sites. There was a positive dose-response relationship between LBBP success likelihood and corrected longit-dist with a cut-off of 26.95 mm, whereas there were negative dose-response relationships of LBBP success likelihood to locat-QRSd, locat-LVAT, and locat-LVAT/QRSd with the cut-offs of 142 ms, 92 ms, and 64.7%, respectively. Downward QRS direction in II/III ECG leads was also associated with successful LBBP. Conclusion Longit-dist, locat-QRSd, locat-LVAT, and locat-LVAT/QRSd were quantitative parameters to guide the selection of lead-implanted sites during LBBP implantation.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Quantitative distance and electrocardiographic parameters for lead-implanted site selection to enhance the success likelihood of left bundle branch pacing

Lin

Chen

et al. 2021

Clin Res Cardiol

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“…Successful LBB capture was assumed in patients with a paced QRS morphology in lead V1 showing a right bundle branch block (RBBB) pattern and met at least one of the three criteria including: (1) recording of an LBB potential; (2) short and constant left ventricular activation time (LVAT) at different pacing outputs or abruptly shortened LVAT at high output; and (3) demonstration of selective LBB capture. In addition, the target LBB region could also be located based on the positional relationship between the LBB region and TVA provided by the visualization technique ( 9 ).…”

Section: Methodsmentioning

confidence: 99%

“…The RVP implantation was performed using the conventional transvenous approach, and the ventricular lead was placed at the right ventricle. The implantation procedures of HBP and LBBP were performed using the conventional method or with the guidance of the visualization technique previously described by our team (8)(9)(10). All CSP implantations were performed using the fixed-curve C315 HIS sheath (Medtronic Inc, Minneapolis, MN) and the Select Secure 3830, pacing lead (Medtronic Inc, Minneapolis, MN).…”

Section: Implantation Proceduresmentioning

confidence: 99%

Conduction System Pacing for Post Transcatheter Aortic Valve Replacement Patients: Comparison With Right Ventricular Pacing

Niu

Liu

et al. 2021

Front. Cardiovasc. Med.

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Introduction: For patients who develop atrioventricular block (AVB) following transcatheter aortic valve replacement (TAVR), right ventricular pacing (RVP) may be associated with adverse outcomes. We assessed the feasibility of conduction system pacing (CSP) in patients who developed AVB following TAVR and compared the procedural and clinical outcomes with RVP.Methods: Consecutive patients who developed AVB following TAVR were prospectively enrolled, and were implanted with RVP or CSP. Procedural and clinical outcomes were compared among different pacing modalities.Results: A total of 60 patients were enrolled, including 10 who were implanted with His bundle pacing (HBP), 20 with left bundle branch pacing (LBBP), and 30 with RVP. The HBP group had significantly lower implant success rate, higher capture threshold, and lower R-wave amplitude than the LBBP and RVP groups (p < 0.01, respectively). The RVP group had a significantly longer paced QRS duration (153.5 ± 6.8 ms, p < 0.01) than the other two groups (HBP: 121.8 ± 8.6 ms; LBBP: 120.2 ± 10.6 ms). During a mean follow-up of 15.0 ± 9.1 months, the LBBP group had significantly higher left ventricular ejection fraction (LVEF) (54.9 ± 6.7% vs. 48.9 ± 9.1%, p < 0.05) and shorter left ventricular end-diastolic diameter (LVEDD) (49.7 ± 5.6 mm vs. 55.0 ± 7.7 mm, p < 0.05) than the RVP group. While the HBP group showed trends of higher LVEF (p = 0.016) and shorter LVEDD (p = 0.017) than the RVP group. Four patients in the RVP group died—three deaths were due to progressive heart failure and one was due to non-cardiac reasons. One death in the LBBP group was due to the non-cardiac reasons.Conclusions: CSP achieved shorter paced QRS duration and better cardiac structure and function in post-TAVR patients than RVP. LBBP had a higher implant success rate and better pacing parameters than HBP.

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“…However, locating the His bundle (HB) region can be challenging and time-consuming, resulting in significantly higher fluoroscopic exposure compared to traditional RVP (3). In our previous studies, we found that the procedural and fluoroscopic time (FT) could be shortened by a contrast injection visualization technique, however, the overall FT was still relatively longer (4,5). The higher fluoroscopic exposure can cause damage to both the patients and operators (6).…”

Section: Introductionmentioning

confidence: 99%

Novel Wide-Band Dielectric Imaging System Guided Lead Deployment for His Bundle Pacing: A Feasibility Study

Hua

Liu

et al. 2021

Front. Cardiovasc. Med.

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Introduction: His bundle pacing (HBP) is the most widely used physiological pacing modality, but difficulties in locating the His bundle lead to high fluoroscopic exposure. An electroanatomical mapping (EAM) system can be an efficient tool to achieve HBP implantation with near-zero fluoroscopic visualization.Methods: In the study, 20 patients who had indications for pacemaker implantation were prospectively enrolled and underwent HBP implantation either with the conventional fluoroscopy approach (the standard group) or guided by a novel KODEX-EPD mapping system (the EAM-guided group). The success rate, procedural details, pacing parameters, and procedure-related complications were compared between the two groups.Results: In the study, 20 consecutive patients were randomized with 10 patients in each group. HBP was successfully achieved in nine patients in the standard group and nine patients in the EAM-guided group. The procedural time was similar between the EAM-guided group vs. the standard group (85.40 ± 22.34 vs. 86.50 ± 15.05 min, p = 0.90). In comparison with the standard group, the EAM-guided group had a significant shorter total fluoroscopic time (FT) (1.45 ± 0.58 vs. 12.36 ± 5.46 min, p < 0.01) and His lead fluoroscopic time (HL-FT) (0.84 ± 0.56 vs. 9.27 ± 5.44 min, p < 0.01), while lower total fluoroscopic dose (3.13 ± 1.24 vs. 25.38 ± 11.15 mGy, p < 0.01) and His lead fluoroscopic dose (1.85 ± 1.17 vs. 19.06 ± 11.03 mGy, p < 0.01). No significant differences were observed in paced QRS duration and pacing parameters between the two groups. During a 3-month follow-up, one patient had a capture threshold increased >1 V/1.0 ms in the standard group, while no other complications were recorded in either group.Conclusion: The KODEX-EPD system could facilitate HBP implantation with significantly reduced FT and dose without compromising the procedural time.

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Contrast-enhanced image-guided lead deployment for left bundle branch pacing

Cited by 34 publications

References 13 publications

Quantitative distance and electrocardiographic parameters for lead-implanted site selection to enhance the success likelihood of left bundle branch pacing

Quantitative distance and electrocardiographic parameters for lead-implanted site selection to enhance the success likelihood of left bundle branch pacing

Conduction System Pacing for Post Transcatheter Aortic Valve Replacement Patients: Comparison With Right Ventricular Pacing

Novel Wide-Band Dielectric Imaging System Guided Lead Deployment for His Bundle Pacing: A Feasibility Study

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