Intermediate-term performance and safety of His-bundle pacing leads: A single-center experience

Teigeler, Todd L.; Kolominsky, Jeffrey; Vo, Chau; Shepard, Richard K.; Kalahasty, Gautham; Kron, Jordana; Huízar, José F.; Kaszala, Károly; Tan, Alex Y.; Koneru, Jayanthi N.; Ellenbogen, Kenneth A.; Padala, Santosh K.

doi:10.1016/j.hrthm.2020.12.031

Cited by 96 publications

(91 citation statements)

References 18 publications

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“…[22][23] Bhatt et al, Keene et al and Teigeler et al in their respective single center reports described 8%, 7.5% and 11% rates of lead revision/intervention, respectively. 11,14,24 On the other hand, Chaumont et al reported a much lower incidence of lead revisions in their multicenter experience (3.4%) and Qian et al reported no lead revisions. [25][26] The threshold rises have been postulated to be the result of several mechanisms: 1) a relative lack of muscle in the underling region of the Hisbundle 2) progressive fibrotic changes that occur over time after lead fixation, and 3) progressive degrees of micro-dislodgement.…”

Section: Discussionmentioning

confidence: 97%

A Single Center Experience with Early Adoption of Physiologic Pacing Approaches

Oates

Kawamura

Turagam

et al. 2021

Preprint

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Background: Increasing interest in physiological pacing has been countered with challenges such as accurate lead deployment and increasing pacing thresholds with His-bundle pacing (HBP). More recently, left bundle branch area pacing (LBBAP) has emerged as an alternative approach to physiologic pacing. Objective: To compare procedural outcomes and pacing parameters at follow-up during initial adoption of HBP and LBBAP at a single center. Methods: Retrospective review, from September 2016 to January 2020, identified the first 50 patients each who underwent successful HBP or LBBAP. Pacing parameters were then assessed at first follow-up after implantation and after approximately one year, evaluating for acceptable pacing parameters defined as sensing R-wave amplitude >5 mV, threshold <2.5 V @ 0.5 ms and impedance between 400 and 1200 Ohms. Results: The HBP group was younger with lower ejection fraction compared to LBBP (73.2±15.3 vs 78.2±9.2 years, p=0.047; 51.0±15.9% vs 57.0±13.1%, p = 0.044). Post-procedural QRS widths were similarly narrow (119.8±21.2 vs. 116.7±15.2ms; p = 0.443) in both groups. Significantly fewer patients with HBP met the outcome for acceptable pacing parameters at initial follow-up (56.0% vs 96.4%, p = 0.001) and most recent follow-up (60.7% vs 94.9%, p = <0.001; at 399±259 vs. 228±124 days, p = <0.001). More HBP patients required lead revision due to early battery depletion (0 vs 13.3%, at an average of 664 days). Conclusion: During initial adoption, as compared with LBBAP, HBP is associated with a significantly higher frequency of unacceptable pacing parameters, energy consumption, and lead revisions.

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Section: Discussionmentioning

confidence: 97%

A Single Center Experience with Early Adoption of Physiologic Pacing Approaches

Oates

Kawamura

Turagam

et al. 2021

Preprint

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“… 9 However, it may be limited by elevated pacing thresholds at follow-up and in a recent registry study, loss of His bundle capture was found in 17% during a 2-year follow-up period. 10 Left bundle branch area pacing has been recently proposed as a method to reverse LBBB at lower thresholds 1–3 and is usually achieved with delivery tools and techniques for HBP, with the electrode fixed deep in the interventricular septum via an RV approach. The ability to perform temporary LBBAP via a retrograde transaortic approach has been demonstrated, with favourable electrical resynchronization; 7 however, permanent placement of a lead to the LV septum is not feasible due to the risk of embolic stroke.…”

Section: Discussionmentioning

confidence: 99%

Technical feasibility of leadless left bundle branch area pacing for cardiac resynchronization: a case series

Elliott

Jacon

Sidhu

et al. 2021

European Heart Journal - Case Reports

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Background Left bundle branch area pacing (LBBAP) is a novel form of conduction system pacing which can reverse left bundle branch block and deliver cardiac resynchronisation therapy (CRT). The WiSE-CRT system delivers leadless endocardial pacing with symptomatic and left ventricular (LV) remodelling improvements following intervention. We report the technical feasibility of delivering leadless LBBAP using the WiSE-CRT system. Case Summary In case 1, a 57-year-old male with ischaemic cardiomyopathy and complete heart block underwent implantation of the WiSE-CRT system, using a retrograde trans-aortic approach, after failed conventional CRT. Temporary left bundle stimulation from the LV septum achieved superior electrical resynchronisation and equivalent haemodynamic response compared to endocardial pacing at the lateral LV wall. In case 2, an 82-year-old gentleman with tachyarrhythmia-induced cardiomyopathy underwent WiSE-CRT implantation via a trans-septal intra-atrial approach, with the endocardial electrode successfully deployed in the LV septum. Discussion Here we report the first case of deployment of the WiSE-CRT endocardial electrode in the LV septum, and demonstrate the technical feasibility of leadless LBBAP. Entirely leadless CRT is an attractive option for patients with venous access issues or recurrent lead complications and has previously been successful using the WiSE-CRT system and a leadless pacemaker in the right ventricle. Further studies are required to assess long-term efficacy and safety of leadless LBBAP.

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“…However, HBP could not recruit the bundle branches and narrow the QRS width due to failure of pacing beyond the site of conduction block in some patients with PVs, especially in patients undergoing TAVR surgery. Furthermore, HBP may lead to an increase in pacing threshold and lead revision ( 18 , 19 ). Sharma et al ( 14 ) reported that permanent HBP was achieved in 93% of patients with PVs.…”

Section: Discussionmentioning

confidence: 99%

Feasibility and Safety of Permanent Left Bundle Branch Pacing in Patients With Conduction Disorders Following Prosthetic Cardiac Valves

Wei

Liao

et al. 2021

Front. Cardiovasc. Med.

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Background: The feasibility and safety of left bundle branch pacing (LBBP) in patients with conduction diseases following prosthetic valves (PVs) have not been well described.Methods: Permanent LBBP was attempted in patients with PVs. Procedural success and intracardiac electrical measurements were recorded at implant. Pacing threshold, complications, and echocardiographic data were assessed at implant and follow-up visit.Results: Twenty-two consecutive patients with atrioventricular (AV) conduction disturbances (10 with AV nodal block and 12 with infranodal block) underwent LBBP. The PVs included aortic valve replacement (AVR) in six patients, mitral valve repair or replacement (MVR) with tricuspid valve ring (TVR) in four patients, AVR with TVR in one patient, AVR with MVR plus TVR in three patients, transcatheter aortic valve replacement (TAVR) in five patients, and MVR alone in three patients. LBBP succeeded in 20 of 22 (90.9%) patients. LBB potential was observed in 15 of 22 (68.2%) patients, including 10 of 15 (66.7%) patients with AVR/TAVR and five of seven (71.4%) patients without AVR/TAVR. AVR and TVR served as good anatomic landmarks for facilitating the LBBP. The final sites of LBBP were 17.9 ± 1.4 mm inferior to the AVR and 23.0 ± 3.2 mm distal and septal to the TVR. The paced QRS duration was 124.5 ± 13.8 ms, while the baseline QRS duration was 120.0 ± 32.5 ms (P = 0.346). Pacing threshold and R-wave amplitude at implant were 0.60 ± 0.16 V at 0.5 ms and 11.9 ± 5.5 mV and remained stable at the mean follow-up of 16.1 ± 10.8 months. No significant exacerbation of tricuspid valve regurgitation was observed compared to baseline.Conclusion: Permanent LBBP could be feasibly and safely obtained in the majority of patients with PVs. The location of the PV might serve as a landmark for guiding the final site of the LBBP. Stable pacing parameters were observed during the follow-up.

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Intermediate-term performance and safety of His-bundle pacing leads: A single-center experience

Cited by 96 publications

References 18 publications

A Single Center Experience with Early Adoption of Physiologic Pacing Approaches

A Single Center Experience with Early Adoption of Physiologic Pacing Approaches

Technical feasibility of leadless left bundle branch area pacing for cardiac resynchronization: a case series

Feasibility and Safety of Permanent Left Bundle Branch Pacing in Patients With Conduction Disorders Following Prosthetic Cardiac Valves

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