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Pham-Trung C, Veloza-Urrea D, Segura-Domínguez M, De la Rosa Rojas Y, Aguilera-Agudo C, García-Izquierdo EA, García-Rodríguez D, Jiménez-Sánchez D, Lorente-Ros A, Mingo-Santos S, Gonzalez-Lopez E, Domínguez F, Garcia-Pavia P, Toquero-Ramos J, Fernández-Lozano I, Castro-Urda V. Feasibility and safety of left bundle branch area pacing in cardiac amyloidosis. A single center experience. Pacing Clin Electrophysiol 2024; 47:149-155. [PMID: 38055612 DOI: 10.1111/pace.14894] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 09/25/2023] [Accepted: 11/17/2023] [Indexed: 12/08/2023]
Abstract
BACKGROUND Conventional right ventricle (RV) pacemaker stimulation has been associated with worse clinical outcomes in patients with cardiac amyloidosis (CA). Left bundle branch area pacing (LABPP) has been suggested as a promising alternative. We sought to assess the safety, feasibility, and outcomes of LABPP in patients with CA. METHODS We retrospectively analyzed echocardiography and pacing parameters and clinical outcomes in 23 consecutive patients with CA and LBBAP implanted from June 2020 to October 2022. RESULTS LBBAP was successfully performed in 22 over 23 patients (19 male, 78.6 ± 11.7 years, 20 ATTR, mean LVEF 45.5 ± 16.2%). After the procedure, 9 patients showed Qr pattern and 11 a qR pattern in V1 on ECG. Average procedure time was 67 ± 28 min. After 7.7 ± 5.2 months follow-up, no procedure-related complications had occurred. Although, a significant reduction in QRS width (p = .001) was achieved, we did not observe significant changes in LVEF and Nt ProBNP at 6 months of follow-up. Pacing parameters were stable during follow-up: LBB capture threshold and R wave amplitude were 1.0 ± 0.5 V and 10.6 ± 6.0 mV versus 0.8 ± 0.1 V, p = .21 and 10.6 ± 5.1 mV (p = .985) at follow up. CONCLUSION LBBAP is safe and feasible pacing technique for patients with CA. LBBAP is associated with significant narrowing of QRSd without worsening in LVEF and Nt-proBNP.
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Affiliation(s)
- Chinh Pham-Trung
- Electrophysiology Unit, Cardiology Service. Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Darwin Veloza-Urrea
- Electrophysiology Unit, Cardiology Service. Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Melodie Segura-Domínguez
- Electrophysiology Unit, Cardiology Service. Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Yuleisy De la Rosa Rojas
- Electrophysiology Unit, Cardiology Service. Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Cristina Aguilera-Agudo
- Electrophysiology Unit, Cardiology Service. Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | | | - Daniel García-Rodríguez
- Electrophysiology Unit, Cardiology Service. Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Diego Jiménez-Sánchez
- Electrophysiology Unit, Cardiology Service. Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Alvaro Lorente-Ros
- Electrophysiology Unit, Cardiology Service. Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Susana Mingo-Santos
- Cardiac imaging Unit, Cardiology Service. Hospital universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Esther Gonzalez-Lopez
- Heart Failure and Inherited Cardiac Diseases Unit, Department of Cardiology, Hospital Universitario Puerta de Hierro Majadahonda, IDIPHISA, CIBERCV, Madrid, Spain
| | - Fernando Domínguez
- Heart Failure and Inherited Cardiac Diseases Unit, Department of Cardiology, Hospital Universitario Puerta de Hierro Majadahonda, IDIPHISA, CIBERCV, Madrid, Spain
| | - Pablo Garcia-Pavia
- Heart Failure and Inherited Cardiac Diseases Unit, Department of Cardiology, Hospital Universitario Puerta de Hierro Majadahonda, IDIPHISA, CIBERCV, Madrid, Spain
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | - Jorge Toquero-Ramos
- Electrophysiology Unit, Cardiology Service. Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Ignacio Fernández-Lozano
- Electrophysiology Unit, Cardiology Service. Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Víctor Castro-Urda
- Electrophysiology Unit, Cardiology Service. Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
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De Pooter J, Bulava A, Gras D, Timmer S, Chin-Pang Chan G, Clementy N, Pathak RK, Healy S, Lüsebrink U, Zanon F. Utility of a guiding catheter for conduction system pacing: An early multicenter experience. Heart Rhythm O2 2024; 5:8-16. [PMID: 38312208 PMCID: PMC10837172 DOI: 10.1016/j.hroo.2023.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2024] Open
Abstract
Background Conduction system pacing (CSP), either as His bundle pacing (HBP) or as left bundle branch area pacing (LBBAP), may be superior to right ventricular apical or septal pacing. Objective The study sought to present acute results for a new guiding catheter (Biotronik Selectra 3D) designed for CSP implantations of a retractable screw-in lead (Biotronik Solia S). Methods The primary endpoint of the prospective, international nonrandomized BIO|MASTER.Selectra 3D study was freedom from catheter-related serious adverse device effects (SADEs) within 1 week of lead implantation. Results Of 157 enrolled patients, CSP was achieved in 147 (93.6%) patients. No SADEs occurred within 7 days. LBBAP was achieved in 82 patients (45 as crossover from an HBP attempt) and HBP in 65 (44.2%) patients. In centers considering both HBP and LBBAP, the CSP implantation success approached 99%. Successful CSP implantations lasted on average ∼50 minutes (fluoroscopy ∼6 minutes). Most procedures (87.9%) needed only 1 catheter, even after switch from HBP to LBBAP. The catheter's handling was rated largely positive. In patients without bundle branch block, mean QRS duration increased from 106 ms (intrinsic) to 122 ms (CSP) (P = .001). In patients with bundle branch block, mean QRS duration decreased from 151 ms (intrinsic) to 137 ms (CSP) (P = .004). Conclusion The Selectra 3D catheter is a valuable tool for HBP and LBBAP implantations of the stylet-supported pacemaker leads. When implanters considered both HBP and LBBAP, the success rate was ∼99%. Flexibility to change between different approaches may be advisable in heterogeneous and challenging areas, such as CSP implantations.
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Affiliation(s)
| | - Alan Bulava
- České Budějovice Hospital, Faculty of Health and Social Sciences, Cardiology, University of South Bohemia, České Budějovice, Czech Republic
| | - Daniel Gras
- Hôpital Privé du Confluent, Cardiology, Nantes, France
| | - Stefan Timmer
- Noordwest Ziekenhuisgroep, Cardiology, Alkmaar, the Netherlands
| | | | - Nicolas Clementy
- Centre Hospitalier Régional Universitaire de Tours, Cardiology, Chambray-lès-Tours, France
| | - Rajeev K Pathak
- Canberra Heart Rhythm, Australian National University, Cardiology, Garran, Australian Capital Territory, Australia
| | - Stewart Healy
- Monash Medical Centre, Cardiology, Melbourne, Victoria, Australia
| | - Ulrich Lüsebrink
- Universitätsklinikum Gießen und Marburg, Kardiologie, Marburg, Germany
| | - Francesco Zanon
- Santa Maria della Misericordia, Arrhythmia and Electrophysiology Unit, Rovigo, Italy
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Calvo D, Pombo M, Benito B, Cano Ó, Fidalgo Andrés ML, Gómez-Bueno M, Jiménez Candil FJ, Lillo IM, Moriña-Vázquez P, Peñafiel-Verdú P, Rincón LM, Tolosana JM, Avanzas P, Berga Congost G, Boraita A, Bueno H, Calvo D, Campuzano R, Delgado V, Dos L, Ferreira-Gonzalez I, Gomez Doblas JJ, Pascual Figal D, Sambola A, Viana Tejedor A, Ferreiro JL, Alfonso F. Comments on the 2021 ESC guidelines on cardiac pacing and cardiac resynchronization therapy. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2022; 75:370-374. [PMID: 35090861 DOI: 10.1016/j.rec.2021.11.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 11/02/2021] [Indexed: 06/14/2023]
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Calvo D, Pombo M. Comentarios a la guía ESC 2021 sobre estimulación cardiaca y terapia de resincronización. Rev Esp Cardiol 2022. [DOI: 10.1016/j.recesp.2021.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Bermúdez-Jiménez FJ, Molina-Lerma M, Macías-Ruiz R, Sánchez-Millán P, Jiménez-Jáimez J, Álvarez M. Initial experience with left bundle branch area pacing in patients with transthyretin cardiac amyloidosis. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2022; 75:182-184. [PMID: 34674964 DOI: 10.1016/j.rec.2021.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 08/09/2021] [Indexed: 06/13/2023]
Affiliation(s)
- Francisco José Bermúdez-Jiménez
- Servicio de Cardiología, Hospital Universitario Virgen de las Nieves, Granada, Spain; Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain; Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.
| | - Manuel Molina-Lerma
- Servicio de Cardiología, Hospital Universitario Virgen de las Nieves, Granada, Spain; Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
| | - Rosa Macías-Ruiz
- Servicio de Cardiología, Hospital Universitario Virgen de las Nieves, Granada, Spain; Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
| | - Pablo Sánchez-Millán
- Servicio de Cardiología, Hospital Universitario Virgen de las Nieves, Granada, Spain; Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
| | - Juan Jiménez-Jáimez
- Servicio de Cardiología, Hospital Universitario Virgen de las Nieves, Granada, Spain; Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
| | - Miguel Álvarez
- Servicio de Cardiología, Hospital Universitario Virgen de las Nieves, Granada, Spain; Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
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Experiencia inicial en estimulación en el área de la rama izquierda en pacientes con amiloidosis cardiaca por transtirretina. Rev Esp Cardiol 2022. [DOI: 10.1016/j.recesp.2021.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Ferrari ADL, Gazzoni GF, Domingues LML, Willes JCF, Cabral GC, Ferreira FVC, Lodi LO, Reis G. Sincronia Ventricular na Estimulação Cardíaca Parahissiana: Alternativa por Ativação Cardíaca Fisiológica (Estimulação Indireta do Feixe de His)? Arq Bras Cardiol 2021; 118:488-502. [PMID: 35262586 PMCID: PMC8856677 DOI: 10.36660/abc.20201233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 02/24/2021] [Indexed: 11/23/2022] Open
Abstract
Fundamento A estimulação cardíaca artificial (ECA) por captura direta ou indireta do feixe de His resulta em contração ventricular sincrônica (ECA fisiológica). Objetivos Comparar sincronia cardíaca, características técnicas e resultados de parâmetros eletrônicos entre duas técnicas de ECA indireta do feixe de His: a não seletiva e a parahissiana. Métodos Intervenção experimental (novembro de 2019 a abril de 2020) com implante de marca-passo definitivo (MPd) DDD em pacientes com fração de ejeção ventricular esquerda > 35%. Foram comparadas a sincronia cardíaca resultante mediante algoritmo de análise eletrocardiográfica da variância espacial do QRS e as características técnicas associadas a cada método entre ECA hissiana não seletiva (DDD-His) e parahissiana (DDD-Var). Resultados De 51 pacientes (28 homens), 34 (66,7%) foram alocados no grupo DDD-Var e 17 (33,3%), no grupo DDD-His, com idade média de 74 e 79 anos, respectivamente. No grupo DDD-Var, a análise da variância espacial do QRS (índice de sincronia ventricular) mostrou melhora após o implante de MPd (p < 0,001). Ao ECG pós-implante, 91,2% dos pacientes do grupo DDD-Var mostraram padrão fisiológico de ECA, comprovando ativação similar à do DDD-His (88,2%; p = 0,999). O eixo do QRS estimulado também foi similar (fisiológico) para ambos os grupos. A mediana do tempo de fluoroscopia do implante foi de 7 minutos no grupo DDD-Var e de 21 minutos no DDD-His (p < 0,001), favorecendo a técnica parahissiana. A duração média do QRS aumentou nos pacientes do DDD-Var (114,7 ms pré-MPd e 128,2 ms pós-implante, p = 0,044). A detecção da onda R foi de 11,2 mV no grupo DDD-Var e de 6,0 mV no DDD-His (p = 0,001). Conclusão A ECA parahissiana comprova recrutamento indireto do feixe de His, mostrando-se uma estratégia eficaz e comparável à ECA fisiológica ao resultar em contração ventricular sincrônica similar à obtida por captura hissiana não seletiva.
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Comentarios a la guía ESC/EACTS 2020 sobre el diagnóstico y tratamiento de la fibrilación auricular. Rev Esp Cardiol (Engl Ed) 2021. [DOI: 10.1016/j.recesp.2020.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Comments on the 2020 ESC/EACTS guidelines for the management of atrial fibrillation. ACTA ACUST UNITED AC 2021; 74:378-383. [PMID: 33736964 DOI: 10.1016/j.rec.2020.11.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 11/24/2020] [Indexed: 12/22/2022]
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