Left bundle branch pacing: A comprehensive review

Ponnusamy, Shunmuga Sundaram; Arora, Vanita; Namboodiri, Narayanan; Kumar, Vivek; Kapoor, Aditya; Vijayaraman, Pugazhendhi

doi:10.1111/jce.14681

Cited by 142 publications

(157 citation statements)

References 37 publications

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“…The narrow QRS duration with LBBAP is likely due to the dense arborization of the LBB and Purkinje network allowing rapid conduction and simultaneous capture of a greater part of the LV. LBBAP is associated with technically easier lead implantation, shorter learning curve, higher implant success rates, and stable and reliable lead parameters 26–28 . The differences between these two forms of CSP can be explained by the anatomy and histology of the structures surrounding the His bundle and LBB area, and are detailed in Table 1 and Figure 8.…”

Section: Implications For Conduction System Pacingmentioning

confidence: 99%

Anatomy of the cardiac conduction system

Padala

Cabrera

Ellenbogen

2020

Pacing Clinical Electrophis

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The specialized cardiomyocytes that constitute the conduction system in the human heart, initiate the electric impulse and result in rhythmic and synchronized contraction of the atria and ventricles. Although the atrioventricular (AV) conduction axis was described more than a century ago by Sunao Tawara, the anatomic pathway for propagation of impulse from atria to the ventricles has been a topic of debate for years. Over the past 2 decades, there has been a resurgence of conduction system pacing (CSP) by implanting pacing leads in the His bundle region in lieu of chronic right ventricular pacing that is associated with worse clinical outcomes. The inherent limitations of implanting the leads in the His bundle region has led to the emergence of left bundle branch area pacing in the past 3 years as an alternative strategy for CSP. The clinical experience from performing CSP has helped electrophysiologists gain deeper insight into the anatomy and physiology of cardiac conduction system. This review details the anatomy of the cardiac conduction system, and highlights some of the recently published articles that aid in better understanding of the AV conduction axis and its variations, the knowledge of which is critical for CSP. The remarkable evolution in technology has led to visualization of the cardiac conduction system using noninvasive, nondestructive high‐resolution contrast‐enhanced micro‐computed tomography imaging that may aid in future CSP. We also discuss from anatomical perspective, the differences seen clinically with His bundle pacing and left bundle branch area pacing.

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Section: Implications For Conduction System Pacingmentioning

confidence: 99%

Anatomy of the cardiac conduction system

Padala

Cabrera

Ellenbogen

2020

Pacing Clinical Electrophis

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“…The copyright holder for this preprint this version posted October 6, 2020. ; https://doi.org/10.1101/2020.10.04.20206573 doi: medRxiv preprint Implantation procedure For all procedures, only the 3830 model lead and delivery sheaths from the SelectSite tm family were used (Medtronic Inc., USA). The LBB-pacing device implantation generally followed the methods recently described by Huang, Vijayaraman and others, 2,3,6 albeit, with some potentially important modifications delineated below. The implantation site was chosen on the basis of the right ventricular septal pacemapping and the tricuspid summit position, no extensive search for His bundle potential was performed.…”

Section: Fixation Beats Definition and Analysismentioning

confidence: 99%

“…LBB capture was diagnosed when either direct proof was obtained with differential pacing output or programmed / burst stimulation or one of the indirect, arbitrary criteria was present (time to R wave peak in V5/V6 < 85 ms, QRS ≤ 120 ms, or LBB potential on the 3830 lead electrogram). 2,[6][7][8]…”

Section: Fixation Beats Definition and Analysismentioning

confidence: 99%

Fixation beats – a novel marker for reaching the left bundle branch area during deep septal lead implantation

Jastrzębski

Kiełbasa

Moskal

et al. 2020

Preprint

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Introduction: One of the challenges of left bundle branch (LBB) pacing is to place the pacing lead deep enough in the septum to obtain capture of the LBB, yet not too deep to avoid perforation. We hypothesized that the occurrence of the ectopic beats of qR/rsR morphology in V1 lead (fixation beats) during the lead fixation would predict that the final desired intraseptal lead depth was just reached, while the lack of fixation beats would indicate too shallow position, and need for more lead rotations. Methods: Consecutive patients during LBB pacing device implantation were analyzed retrospectively and then prospectively with respect to the occurrence of the fixation beats during each episode of lead rotation. We compared the presence of fixation beats during the lead rotation event directly before the LBB capture area depth was reached versus during the events before intermediate/unsuccessful positions. Results: A total of 339 patients and 1278 lead rotation events were analyzed. In the retrospective phase, the fixation beats were observed in 327/339 of final lead positions and in 9/939 of intermediate lead positions (p<0.001). The sensitivity, specificity, positive and negative predictive value of the LBB area fixation beats as a marker for reaching the LBB capture area was 96.4%, 99.0%, 97.3% and 99.0%, respectively. In the prospective, fixation-beats-guided, implantation phase the fixation beats were observed in all patients and only at the LBB capture depth. Conclusions: Monitoring fixation beats during deep septal lead deployment can facilitate the procedure and possibly increase the safety of lead implantation.

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“…However, in some patients implementation of HB pacing may be challenging or they may lose HB capture during follow-up due to undersensing and/or increase of HB threshold. For patients with HB pacing failure, the solution is to pace distal ventricular conduction system or implementation of classic ventricular myocardial stimulation [1,2].…”

Section: Removalmentioning

confidence: 99%

“…Therefore, we believe that it is reasonable to attempt to remove the dysfunctional HB lead, especially in young people. Implantation of the ventricular lead in the LBB region is feasible [4] and seems to be a good alternative for patients after failed HB pacing, as it offers much lower pacing thresholds, better sensing and 'bypasses' the potentially damaged or fibrous region of HB [1,2].…”

Section: Removalmentioning

confidence: 99%