Septal Coronary Artery Fistula Following Left Bundle Branch Area Pacing

Pooter, Jan De; Calle, Simon; Demulier, Laurent; Timmermans, Frank; Heuverswyn, Frédéric Van

doi:10.1016/j.jacep.2020.08.038

Cited by 12 publications

(15 citation statements)

References 2 publications

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“…According to an evaluation of postoperative echocardiography by De Pooter et al, this kind of fistula is asymptomatic, and several deep screw attempts might be a possible risk factor for the development of a fistula. 5 Consistent with their findings, our case required three deep screw attempts, and the two failed screw attempts may be responsible for fistula formation. In this case, we additionally evaluated left-to-right shunt volume and the findings of coronary angiography to investigate the detailed pathology and extent of the fistula.…”

Section: Discussionsupporting

confidence: 90%

“…In terms of inserting a lead deeply into the IVS, septal coronary artery fistula could be a more common complication during LBBAP. According to an evaluation of postoperative echocardiography by De Pooter et al., this kind of fistula is asymptomatic, and several deep screw attempts might be a possible risk factor for the development of a fistula 5 . Consistent with their findings, our case required three deep screw attempts, and the two failed screw attempts may be responsible for fistula formation.…”

Section: Discussionsupporting

confidence: 88%

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Septal coronary artery fistula after left bundle branch area pacing assessed by multi‐imaging modalities and shunt volume quantification

Kato

Ota

Murakami

et al. 2022

Pacing Clinical Electrophis

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Septal coronary artery fistula is a rare but concerning complication of left bundle branch area pacing (LBBAP). We report the case of an 82‐year‐old man who was indicated for cardiac resynchronization therapy and underwent LBBAP. The patient had no chest symptoms during or after implantation. Postoperative echocardiography demonstrated a new abnormal tunnel inside the interventricular septum (IVS) and shunt flow from the IVS toward the right ventricle. Coronary angiography confirmed a septal coronary artery fistula, which might have been formed by failed deep screw attempts. Since the shunt volume assessed by the Qp/Qs was small, the patient was treated conservatively.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionsupporting

confidence: 88%

Septal coronary artery fistula after left bundle branch area pacing assessed by multi‐imaging modalities and shunt volume quantification

Kato

Ota

Murakami

et al. 2022

Pacing Clinical Electrophis

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“…Transthoracic echocardiography the day after implant detected a septal coronary artery fistula in one patient who underwent LBBAP with an SDL 17 . This complication remained completely asymptomatic and without clinical signs for ischemia during 6 months follow‐up.…”

Section: Resultsmentioning

confidence: 97%

Left bundle branch area pacing using stylet‐driven pacing leads with a new delivery sheath: A comparison with lumen‐less leads

Pooter

Calle

Timmermans

et al. 2021

Cardiovasc electrophysiol

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Introduction Left bundle branch area pacing (LBBAP) aims to achieve physiological pacing by capturing the conduction system in the area of the left bundle branch. LBBAP has exclusively been performed using lumen‐less pacing leads (LLLs) with fixed helix design. This study explores the feasibility, safety, and pacing characteristics of LBBAP using stylet‐driven leads (SDLs) with an extendable helix design. Methods Patients, in which LBBAP was attempted for bradycardia or heart failure pacing indications, were prospectively enrolled at the Ghent University Hospital. LBBAP was attempted with two different systems: 1/LLL with fixed helix (SelectSecure 3830, Medtronic Inc.) delivered through a preshaped sheath (C315His Medtronic Inc.) and 2/SDL with extendable helix (Solia S60, Biotronik, SE & CO) delivered through a new delivery sheath (Selectra 3D, Biotronik). Results The study enrolled 50 patients (mean age: 70 ± 14 years, 44% females). LBBAP with SDL was successful in 20/23 (87%) patients compared with 24/27 (89%) of patients in the LLL group (p = 0.834). Screw attempts, screw implant depth, procedural, and fluoroscopy times were comparable among both groups. Acute LBBAP thresholds were low and comparable between SDL and LLL (0.5 ± 0.15 V vs. 0.4 ± 0.17 V, p = 0.251). Pacing thresholds remained low at 3 ± 2.1 months of follow up in both groups and no lead revisions were necessary. Postprocedural echocardiography revealed a septal coronary artery fistula in one patient with SDLLBBAP. Conclusion LBBAP using stylet‐driven pacing leads is feasible and yields comparable implant success to LBBAP with LLLs. LBBAP thresholds are low and comparable with both types of leads.

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“…However, SCAF following LBBAP is rarely reported. This is explained by the fact that SCAF are rare, usually asymptomatic, and easily missed if no contrast injection is used or if no targeted echocardiography is performed early after LBBAP implant 8,17 . The low number of SCAF in our registry, despite contrast injections and dedicated echo follow‐up in the majority of patients, confirms the safety of LBBAP using SDL leads.…”

Section: Discussionmentioning

confidence: 99%

“…During implant, perforation of the lead through the interventricular septum was suspected if one of the following events occurred: sudden decrease in pacing impedance of >200 Ω, high unipolar pacing thresholds >3 V or leakage of contrast into the left ventricle. The integrity of the septum was further evaluated on echocardiography by screening for SCAF (diastolic timed color Doppler jets originating from the septum) 17 septal hematoma and ventricular septal defects pre hospital discharge.…”

Section: Methodsmentioning

confidence: 99%

Initial experience of left bundle branch area pacing using stylet‐driven pacing leads: A multicenter study

Pooter

Özpak

Calle

et al. 2022

Cardiovasc electrophysiol

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Disclosures: Dr. De Pooter reports speaker fees and honoraria from Medtronic and Biotronik. Dr. Peytchev and dr. Heggermont report that their research institution (CRI Aalst) receives consultancy fees on their behalf from Medtronic, Biotronik, St Jude Medical, Boston Scientific and Microport. Dr Wauters reports speaker and consultancy fees from Biotronik. Dr. le Polain de Waroux reports nonsignificant speaker fees and honoraria for proctoring and teaching activities from Medtronic, Boston Scientific, Abbott and Biotronik. The other authors report no disclosures. Dr. Tung reports speaker and consulting honoraria from Medtronic, Boston Scientific, Abbott, and Biotronik.

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Septal Coronary Artery Fistula Following Left Bundle Branch Area Pacing

Cited by 12 publications

References 2 publications

Septal coronary artery fistula after left bundle branch area pacing assessed by multi‐imaging modalities and shunt volume quantification

Septal coronary artery fistula after left bundle branch area pacing assessed by multi‐imaging modalities and shunt volume quantification

Left bundle branch area pacing using stylet‐driven pacing leads with a new delivery sheath: A comparison with lumen‐less leads

Initial experience of left bundle branch area pacing using stylet‐driven pacing leads: A multicenter study

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