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Vijayaraman P, Foo D, Lim TSE, Diamantakos E, Verma S, Hourdain J, Pandurangi U, Bhargava K, Zanon F, Stone J, Lee K, Nair D. Result of the left bundle branch area pacing data collection registry, an international multicenter study of conduction system pacing with a Tendril STS 2088 stylet-driven lead. J Cardiovasc Electrophysiol 2024. [PMID: 38757909 DOI: 10.1111/jce.16274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 03/19/2024] [Accepted: 03/27/2024] [Indexed: 05/18/2024]
Abstract
INTRODUCTION Left bundle branch area (LBBA) pacing (LBBAP) has been proposed as an alternative therapy option in patients indicated for cardiac pacing to treat bradycardia or heart failure. The aim of the study was to evaluate the safety and effectiveness of LBBAP in patients implanted with a Tendril 2088 stylet-driven lead. METHODS The international retrospective data collection registry included 11 sites from 5 countries globally. Patients with attempted implants of the Tendril lead in the LBBA were followed for at least 6 months post the implant attempt. The primary safety and efficacy endpoints were freedom from LBBAP lead-related serious adverse events and the composite of LBBA capture threshold of ≤2.0 V and R-wave amplitudes ≥5 mV (or ≥value at implant), respectively. RESULTS Of 221 patients with attempted implants of the Tendril 2088 lead in the LBBA, 91.4% (202/221) had successful implants for LBBAP. Regardless of the LBBAP implant success, all patients were followed for at least 6 months (8.7 ± 7.3 months). Baseline characteristics: 44% female, 84% ≥65 years old, 34% coronary artery disease, and 86% of primary indications for pacemaker implant. Both primary safety and effectiveness endpoints were met (freedom from LBBAP lead-related serious adverse device effects of 99.5% and electrical performance composite success rate of 93%). The capture thresholds in LBBAP at implant and 6 months were 0.8 ± 0.3 V@0.4 ± 0.1 ms and 0.8 ± 0.3 V@0.4 ± 0.1 ms. The rate of patients with capture threshold rise ≥1 V was 1.5% through 6 months. The R-wave amplitudes in LBBAP at implant and 6 months were 9.3 ± 3.2 mV and 10.6 ± 3.0 mV. CONCLUSIONS This large multicenter study demonstrates that the stylet-driven Tendril™ STS 2088 lead is safe and effective for LBBAP with high success and low complication rates.
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Affiliation(s)
- Pugazhendhi Vijayaraman
- Geisinger Wyoming Valley Medical Center, Geisinger Heart Institute, Wilkes-Barre, Pennsylvania, USA
| | - David Foo
- Tan Tock Seng Hospital, Singapore, Singapore
| | | | | | - Sumit Verma
- Baptist Heart and Vascular Institute, Pensacola, Florida, USA
| | | | | | | | | | - James Stone
- North Mississippi Medical Center, Tupelo, Mississippi, USA
| | | | - Devi Nair
- Arrhythmia Research Group, Jonesboro, Arkansas, USA
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Tan ESJ, Soh R, Lee JY, Boey E, Chan SP, Lim TW, Yeo WT, Leong KMW, Seow SC, Kojodjojo P. Prognostic benefits of His-Purkinje capture in physiological pacemakers for bradycardia. J Cardiovasc Electrophysiol 2024; 35:727-736. [PMID: 38351331 DOI: 10.1111/jce.16211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 10/11/2023] [Accepted: 01/29/2024] [Indexed: 04/10/2024]
Abstract
INTRODUCTION Clinical outcomes of long-term ventricular septal pacing (VSP) without His-Purkinje capture remain unknown. This study evaluated the differences in clinical outcomes between conduction system pacing (CSP), VSP, and right ventricular pacing (RVP). METHODS Consecutive patients with bradycardia indicated for pacing from 2016 to 2022 were prospectively followed for the clinical endpoints of heart failure (HF)-hospitalizations and all-cause mortality at 2 years. VSP was defined as septal pacing due to unsuccessful CSP implant or successful CSP followed by loss of His-Purkinje capture within 90 days. RESULTS Among 1016 patients (age 73.9 ± 11.2 years, 47% female, 48% atrioventricular block), 612 received RVP, 335 received CSP and 69 received VSP. Paced QRS duration was similar between VSP and RVP, but both significantly longer than CSP (p < .05). HF-hospitalizations occurred in 130 (13%) patients (CSP 7% vs. RVP 16% vs. VSP 13%, p = .001), and all-cause mortality in 143 (14%) patients (CSP 7% vs. RVP 19% vs. VSP 9%, p < .001). The association of pacing modality with clinical events was limited to those with ventricular pacing (Vp) > 20% (pinteraction < .05). Adjusting for clinical risk factors among patients with Vp > 20%, VSP (adjusted hazard ratio [AHR]: 4.74, 95% confidence interval [CI]: 1.57-14.36) and RVP (AHR: 3.08, 95% CI: 1.44-6.60) were associated with increased hazard of HF-hospitalizations, and RVP (2.52, 95% CI: 1.19-5.35) with increased mortality, compared to CSP. Clinical endpoints did not differ between VSP and RVP with Vp > 20%, or amongst groups with Vp < 20%. CONCLUSION Conduction system capture is associated with improved clinical outcomes. CSP should be preferred over VSP or RVP during pacing for bradycardia.
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Affiliation(s)
- Eugene S J Tan
- Department of Cardiology, National University Heart Centre, Singapore, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
| | - Rodney Soh
- Department of Cardiology, National University Heart Centre, Singapore, Singapore
| | - Jie-Ying Lee
- Department of Cardiology, National University Heart Centre, Singapore, Singapore
| | - Elaine Boey
- Department of Cardiology, Ng Teng Fong General Hospital, Singapore, Singapore
| | - Siew-Pang Chan
- Department of Medicine, Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
| | - Toon Wei Lim
- Department of Cardiology, National University Heart Centre, Singapore, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
| | - Wee Tiong Yeo
- Department of Cardiology, National University Heart Centre, Singapore, Singapore
| | - Kevin M W Leong
- Department of Cardiology, National University Heart Centre, Singapore, Singapore
| | - Swee-Chong Seow
- Department of Cardiology, National University Heart Centre, Singapore, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
| | - Pipin Kojodjojo
- Department of Cardiology, National University Heart Centre, Singapore, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
- Department of Cardiology, Ng Teng Fong General Hospital, Singapore, Singapore
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Seow SC. A novel method to disengage trapped helix during left bundle branch pacing. Heart Rhythm 2024:S1547-5271(24)00283-2. [PMID: 38508298 DOI: 10.1016/j.hrthm.2024.03.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 03/13/2024] [Accepted: 03/14/2024] [Indexed: 03/22/2024]
Affiliation(s)
- Swee-Chong Seow
- Department of Cardiology, National University Hospital, Singapore.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Cano Ó, Navarrete-Navarro J, Zalavadia D, Jover P, Osca J, Bahadur R, Izquierdo M, Navarro J, Subzposh FA, Ayala HD, Martínez-Dolz L, Vijayaraman P, Batul SA. Acute performance of stylet driven leads for left bundle branch area pacing: A comparison with lumenless leads. Heart Rhythm O2 2023; 4:765-776. [PMID: 38204462 PMCID: PMC10774671 DOI: 10.1016/j.hroo.2023.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024] Open
Abstract
Background Lumenless leads (LLLs) are widely used for left bundle branch area pacing (LBBAP). Recently, stylet-driven leads (SDLs) have also been used for LBBAP. Objective The purpose of this study was to evaluate the acute performance of SDLs during LBBAP in comparison with LLLs. Methods Consecutive patients undergoing LBBAP for bradycardia or cardiac resynchronization therapy indications at 2 high-volume, early conduction system pacing adopters, tertiary centers were included from January 2019 to July 2023. Patients received either SDLs or LLLs at the discretion of the implanting physician. Acute performance and follow-up data of both lead types were evaluated. Results A total of 925 LBBAP implants were included, 655 using LLLs and 270 using SDLs. Overall, LBBAP acute success was significantly higher with LLLs than SDLs (95.3% vs 85.1%, respectively; P <.001) even after the learning curve (97% vs 86%; P = .013). LLLs were implanted in more mid-basal septal positions in comparison with SDLs, which tended to be implanted in more inferior and mid-apical septal positions. Acute lead-related complications were higher with SDLs than LLLs (15.9% vs 6.1%, respectively; P <.001) with 15 cases of lead damage during implant (4.4% vs 0.5%; P <.001) but decreased with acquired experience and were comparable in the last 100 patients included in each group. Lead implant and fluoroscopy times were shorter for SDLs, with lead dislodgment occurring in 0.9% with LLLs and 1.5% with SDLs (P = .489). Conclusion Acute lead performance proved to be different between LLLs and SDLs. A specific learning curve should be considered for SDLs even for implanters with extensive previous experience with LLLs.
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Affiliation(s)
- Óscar Cano
- Electrophysiology Section, Cardiology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
- Instituto de Investigación Sanitaria La Fe (IIS La Fe), Valencia, Spain
- Centro de Investigaciones Biomédicas en RED en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Javier Navarrete-Navarro
- Electrophysiology Section, Cardiology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
- Instituto de Investigación Sanitaria La Fe (IIS La Fe), Valencia, Spain
| | | | - Pablo Jover
- Electrophysiology Section, Cardiology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
- Instituto de Investigación Sanitaria La Fe (IIS La Fe), Valencia, Spain
| | - Joaquín Osca
- Electrophysiology Section, Cardiology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
- Instituto de Investigación Sanitaria La Fe (IIS La Fe), Valencia, Spain
- Centro de Investigaciones Biomédicas en RED en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | | | - Maite Izquierdo
- Electrophysiology Section, Cardiology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
- Instituto de Investigación Sanitaria La Fe (IIS La Fe), Valencia, Spain
- Centro de Investigaciones Biomédicas en RED en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Josep Navarro
- Electrophysiology Section, Cardiology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | | | - Hebert D. Ayala
- Electrophysiology Section, Cardiology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
- Instituto de Investigación Sanitaria La Fe (IIS La Fe), Valencia, Spain
| | - Luis Martínez-Dolz
- Electrophysiology Section, Cardiology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
- Instituto de Investigación Sanitaria La Fe (IIS La Fe), Valencia, Spain
- Centro de Investigaciones Biomédicas en RED en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
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Sritharan A, Kozhuharov N, Masson N, Bakelants E, Valiton V, Burri H. Procedural outcome and follow-up of stylet-driven leads compared with lumenless leads for left bundle branch area pacing. Europace 2023; 25:euad295. [PMID: 37766468 PMCID: PMC10563653 DOI: 10.1093/europace/euad295] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 09/21/2023] [Indexed: 09/29/2023] Open
Abstract
AIMS Left bundle branch area pacing (LBBAP) is most often delivered using lumenless leads (LLLs), but may also be performed using stylet-driven leads (SDLs). There are limited reports on the comparison of these tools, mainly limited to reports describing initial operator experience or without detailed procedural data. Our aim was to perform an in-depth comparison of SDLs and LLLs for LBBAP at implantation and follow-up in a larger cohort of patients with experience that extends beyond that of the initial learning curve. METHODS AND RESULTS A total of 306 consecutive patients (age 77 ± 11 years, 183 males) undergoing LBBAP implantation at a single centre were prospectively included. The population was split into two groups of 153 patients based on the initial use of an SDL (from 4 manufacturers) or an LLL. After having discounted the initial learning curve of 50 patients, there was no difference in the success rate between the initial use of lead type (96.0% with SDL vs. 94.3% with LLL, P = 0.56). There were no significant differences in success between lead models. Electrocardiogram and electrical parameters were comparable between the groups. Post-operative macro-dislodgement occurred in 4.3% of patients (essentially within the first day following implantation) and presumed micro-dislodgement with loss of conduction system capture or rise in threshold (occurring mostly during the first month) was observed in 4.7% of patients, without differences between groups. CONCLUSION Left bundle branch area pacing may be safely and effectively performed using either LLLs or SDLs, which provides implanters with alternatives for delivering this therapy.
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Affiliation(s)
- Aarthiga Sritharan
- Cardiac Pacing Unit, Department of Cardiology, University Hospital of Geneva, Rue Gabrielle-Perret-Gentil 4, CH-1211 Genève, Switzerland
| | - Nikola Kozhuharov
- Cardiac Pacing Unit, Department of Cardiology, University Hospital of Geneva, Rue Gabrielle-Perret-Gentil 4, CH-1211 Genève, Switzerland
| | - Nicolas Masson
- Cardiac Pacing Unit, Department of Cardiology, University Hospital of Geneva, Rue Gabrielle-Perret-Gentil 4, CH-1211 Genève, Switzerland
| | - Elise Bakelants
- Cardiac Pacing Unit, Department of Cardiology, University Hospital of Geneva, Rue Gabrielle-Perret-Gentil 4, CH-1211 Genève, Switzerland
| | - Valérian Valiton
- Cardiac Pacing Unit, Department of Cardiology, University Hospital of Geneva, Rue Gabrielle-Perret-Gentil 4, CH-1211 Genève, Switzerland
| | - Haran Burri
- Cardiac Pacing Unit, Department of Cardiology, University Hospital of Geneva, Rue Gabrielle-Perret-Gentil 4, CH-1211 Genève, Switzerland
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Foo D, Tan K, Ng S, Tan LW, Chia PL. Practical and systematic approach using the steerable catheter and stylet-driven lead to deliver safe and effective left bundle branch area pacing. J Cardiovasc Electrophysiol 2023; 34:1944-1950. [PMID: 37565366 DOI: 10.1111/jce.16038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 07/17/2023] [Accepted: 08/01/2023] [Indexed: 08/12/2023]
Abstract
INTRODUCTION Current delivery tools were not designed for left bundle branch area pacing (LBBAP). Challenges using these tools include lack of reach into the right ventricle and poor support for the lead to penetrate the interventricular septum. Concerns using stylet-driven leads (SDL) for LBBAP have been previously highlighted. Knowledge and the technical know-how of using SDL for LBBAP need to be evaluated in a fair and consistent manner. A stepwise approach is devised for use of Agilis HisProTM steerable catheter with Tendril STS Model 2088TC lead for LBBAP and evaluated for safety and reproducibility. METHODS Consecutive patients undergoing LBBAP using the stepwise approach with Agilis HisProTM steerable catheter were analyzed. The safety, efficacy and reproducibility of the technique were evaluated. The lead parameters were analyzed in the immediate (1 day) and short-term period (3-6 months) post implantation. RESULTS LBBAP was attempted in 41 patients using the stepwise approach of which 37 (90.7%) were successful. The lead parameters were stable in the immediate and short-term post implantation in all our patients. There was no significant difference between the group of patients with multiple repositioning of the lead compared to those successful at the 1st attempt. There were no acute or short-term lead and procedural complications. CONCLUSION A stepwise and systematic approach using the Agilis HisProTM steerable catheter and proper handling of the Tendril STS Model 2088TC stylet-driven lead is an important part of the armamentarium to deliver LBBAP in a practical, effective and reproducible manner.
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Affiliation(s)
- David Foo
- Department of Cardiology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Kenny Tan
- Department of Cardiology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Shonda Ng
- Department of Cardiology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Li W Tan
- Department of Cardiology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Pow-Li Chia
- Department of Cardiology, Tan Tock Seng Hospital, Singapore, Singapore
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Tan ESJ, Soh R, Boey E, Lee JY, de Leon J, Chan SP, Gan HH, Seow SC, Kojodjojo P. Comparison of Pacing Performance and Clinical Outcomes Between Left Bundle Branch and His Bundle Pacing. JACC Clin Electrophysiol 2023; 9:1393-1403. [PMID: 37558292 DOI: 10.1016/j.jacep.2022.12.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 12/21/2022] [Accepted: 12/31/2022] [Indexed: 02/24/2023]
Abstract
BACKGROUND Left bundle branch (LBBP) and His-bundle pacing (HBP) provide physiological ventricular activation. OBJECTIVES This study investigated differences in feasibility, device performance, and clinical outcomes between LBBP and HBP. METHODS Consecutive patients with LBBP and HBP from 2018 to 2021 in 2 centers were prospectively studied. The primary endpoint was optimal device performance during follow-up, defined as the presence of pacing thresholds <2.5 V, R-wave amplitude ≥5 V, and absence of conduction system pacing (CSP)-related complications. The secondary endpoint was the composite of heart failure hospitalizations or all-cause mortality. RESULTS Among 338 patients, 282 underwent successful CSP (119 HBP, 163 LBBP). Success rates, CSP-related complications, and need for reoperations did not differ between LBBP and HBP (P > 0.05). Pacing thresholds were lower, whereas R-wave amplitudes and lead impedance were higher in LBBP (P < 0.05). The primary endpoint was more frequent in LBBP than HBP (79% vs 34%; P < 0.001), with LBBP independently associated with 9-fold increased odds of optimal device performance (adjusted OR: 9.31; 95% CI: 5.14-16.86). LBBP was less likely to have increased pacing thresholds by >1 V (1% vs 19% HBP, P < 0.001). The secondary outcome was less frequent in LBBP than HBP (9% vs 24%, P = 0.001), with LBBP trending towards higher event-free survival (HR: 0.62; 95% CI: 0.31-1.23). The secondary outcome was independent of pacing burden or pacing indication. CONCLUSIONS Despite similar feasibility and safety profiles, LBBP confers additional benefits in pacing performance and reliability, shows trends towards improved survival compared to HBP, and should be the preferred first-line CSP modality of choice.
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Affiliation(s)
- Eugene S J Tan
- Department of Cardiology, National University Heart Centre, Singapore; Yong Loo Lin School of Medicine, National University Singapore.
| | - Rodney Soh
- Department of Cardiology, National University Heart Centre, Singapore
| | - Elaine Boey
- Department of Cardiology, Ng Teng Fong General Hospital, Singapore
| | - Jie-Ying Lee
- Department of Cardiology, National University Heart Centre, Singapore
| | - Jhobeleen de Leon
- Department of Cardiology, National University Heart Centre, Singapore
| | - Siew-Pang Chan
- Department of Cardiology, National University Heart Centre, Singapore; Yong Loo Lin School of Medicine, National University Singapore
| | - Hiong-Hiong Gan
- Department of Cardiology, Ng Teng Fong General Hospital, Singapore
| | - Swee-Chong Seow
- Department of Cardiology, National University Heart Centre, Singapore; Yong Loo Lin School of Medicine, National University Singapore
| | - Pipin Kojodjojo
- Department of Cardiology, National University Heart Centre, Singapore; Yong Loo Lin School of Medicine, National University Singapore; Department of Cardiology, Ng Teng Fong General Hospital, Singapore
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Baroni M, Preda A, Varrenti M, Vargiu S, Carbonaro M, Giordano F, Gigli L, Mazzone P. Left Bundle Branch Area Pacing over His Bundle Pacing: How Far Have We Come? J Clin Med 2023; 12:jcm12093251. [PMID: 37176691 PMCID: PMC10179456 DOI: 10.3390/jcm12093251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 04/25/2023] [Indexed: 05/15/2023] Open
Abstract
Implantable cardiac pacemakers have greatly evolved during the few past years, focusing on newer modalities of physiologic cardiac pacing [...].
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Affiliation(s)
- Matteo Baroni
- Cardio-Thoraco-Vascular Department, Electrophysiology Unit, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy
| | - Alberto Preda
- Cardio-Thoraco-Vascular Department, Electrophysiology Unit, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy
| | - Marisa Varrenti
- Cardio-Thoraco-Vascular Department, Electrophysiology Unit, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy
| | - Sara Vargiu
- Cardio-Thoraco-Vascular Department, Electrophysiology Unit, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy
| | - Marco Carbonaro
- Cardio-Thoraco-Vascular Department, Electrophysiology Unit, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy
| | - Federica Giordano
- Cardio-Thoraco-Vascular Department, Electrophysiology Unit, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy
| | - Lorenzo Gigli
- Cardio-Thoraco-Vascular Department, Electrophysiology Unit, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy
| | - Patrizio Mazzone
- Cardio-Thoraco-Vascular Department, Electrophysiology Unit, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy
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Braunstein ED, Kagan RD, Olshan DS, Gabriels JK, Thomas G, Ip JE, Markowitz SM, Lerman BB, Liu CF, Cheung JW. Initial experience with stylet-driven versus lumenless lead delivery systems for left bundle branch area pacing. J Cardiovasc Electrophysiol 2023; 34:710-717. [PMID: 36571159 DOI: 10.1111/jce.15789] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 12/12/2022] [Accepted: 12/18/2022] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Left bundle branch area pacing (LBBP) has emerged as an alternative method for conduction system pacing. While initial experience with delivery systems for stylet-driven and lumenless lead implantation for LBBP has been described, data comparing outcomes of stylet-driven versus lumenless lead implantation for LBBP are limited. In this study, we compare success rates and outcomes of LBBP with stylet-driven versus lumenless lead delivery systems. METHODS Eighty-three consecutive patients (mean age 74.1 ± 11.2 years; 56 [68%] male) undergoing attempted LBBP at a single institution were identified. Cases were grouped by lead delivery systems used: stylet-driven (n = 53) or lumenless (n = 30). Baseline characteristics and procedural findings were recorded and compared between the cohorts. Intermediate term follow-up data on ventricular lead parameters were also compared. RESULTS Baseline characteristics were similar between groups. Successful LBBP was achieved in 77% of patients, with similar success rates between groups (76% in stylet-driven, 80% in lumenless, p = 0.79), and rates of adjudicated LBB capture and other paced QRS parameters were also similar. Compared with the lumenless group, the stylet-driven group had significantly shorter procedure times (90 ± 4 vs. 112 ± 31 min, p = 0.004) and fluoroscopy times (10 ± 5 vs. 15 ± 6 min, p = 0.003). Ventricular lead parameters at follow-up were similar, and rates of procedural complications and need for lead revision were low in both groups. CONCLUSION Delivery systems for stylet-driven and for lumenless leads for LBBP have comparable acute success rates. Long-term follow-up of lead performance following use of the various delivery systems is warranted.
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Affiliation(s)
- Eric D Braunstein
- Division of Cardiology, Weill Cornell Medicine, NewYork-Presbyterian Hospital, New York, New York, USA
| | - Ruth D Kagan
- Division of Cardiology, Weill Cornell Medicine, NewYork-Presbyterian Hospital, New York, New York, USA
| | - David S Olshan
- Division of Cardiology, Weill Cornell Medicine, NewYork-Presbyterian Hospital, New York, New York, USA
| | - James K Gabriels
- Division of Cardiology, Weill Cornell Medicine, NewYork-Presbyterian Hospital, New York, New York, USA
| | - George Thomas
- Division of Cardiology, Weill Cornell Medicine, NewYork-Presbyterian Hospital, New York, New York, USA
| | - James E Ip
- Division of Cardiology, Weill Cornell Medicine, NewYork-Presbyterian Hospital, New York, New York, USA
| | - Steven M Markowitz
- Division of Cardiology, Weill Cornell Medicine, NewYork-Presbyterian Hospital, New York, New York, USA
| | - Bruce B Lerman
- Division of Cardiology, Weill Cornell Medicine, NewYork-Presbyterian Hospital, New York, New York, USA
| | - Christopher F Liu
- Division of Cardiology, Weill Cornell Medicine, NewYork-Presbyterian Hospital, New York, New York, USA
| | - Jim W Cheung
- Division of Cardiology, Weill Cornell Medicine, NewYork-Presbyterian Hospital, New York, New York, USA
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11
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Okubo Y, Miyamoto S, Oguri N, Sakai T, Uotani Y, Miyauchi S, Okamura S, Tokuyama T, Nakano Y. Lead deformation of the stylet-driven lead in left bundle branch area pacing. Heart Rhythm 2023; 20:781-782. [PMID: 36796531 DOI: 10.1016/j.hrthm.2023.02.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 01/27/2023] [Accepted: 02/11/2023] [Indexed: 02/17/2023]
Affiliation(s)
- Yousaku Okubo
- Department of Cardiovascular Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
| | - Shogo Miyamoto
- Department of Cardiovascular Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Naoto Oguri
- Department of Cardiovascular Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Takumi Sakai
- Department of Cardiovascular Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yukimi Uotani
- Department of Cardiovascular Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Shunsuke Miyauchi
- Department of Cardiovascular Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Sho Okamura
- Department of Cardiovascular Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Takehito Tokuyama
- Department of Cardiovascular Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yukiko Nakano
- Department of Cardiovascular Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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12
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De Pooter J. My preferred approach to left bundle branch area pacing: Stylet-driven leads. Heart Rhythm O2 2023; 4:154-156. [PMID: 36873317 PMCID: PMC9975020 DOI: 10.1016/j.hroo.2022.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Affiliation(s)
- Jan De Pooter
- Heart Center, Ghent University Hospital, Ghent, Belgium
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14
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Tan ESJ, Lee JY, Chan SP, Boey E, Seow SC, Kojodjojo P. Simplifying follow-up of left bundle branch pacing leads: Assessment of left bundle branch capture using a programmer only. Heart Rhythm 2023:S1547-5271(23)00114-5. [PMID: 36720442 DOI: 10.1016/j.hrthm.2023.01.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 01/06/2023] [Accepted: 01/20/2023] [Indexed: 01/31/2023]
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15
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Haeberlin A, Canello S, Kummer A, Seiler J, Baldinger SH, Madaffari A, Thalmann G, Ryser A, Gräni C, Tanner H, Roten L, Reichlin T, Noti F. Conduction System Pacing Today and Tomorrow. J Clin Med 2022; 11. [PMID: 36555877 DOI: 10.3390/jcm11247258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 11/29/2022] [Accepted: 12/05/2022] [Indexed: 12/12/2022] Open
Abstract
Conduction system pacing (CSP) encompassing His bundle (HBP) and left bundle branch area pacing (LBBAP) is gaining increasing attention in the electrophysiology community. These relatively novel physiological pacing modalities have the potential to outperform conventional pacing approaches with respect to clinical endpoints, although data are currently still limited. While HBP represents the most physiological form of cardiac stimulation, success rates, bundle branch correction, and electrical lead performance over time remain a concern. LBBAP systems may overcome these limitations. In this review article, we provide a comprehensive overview of the current evidence, implantation technique, device programming, and follow-up considerations concerning CSP systems. Moreover, we discuss ongoing technical developments and future perspectives of CSP.
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Tan ESJ, Soh R, Lee JY, Boey E, Ho KH, Aguirre S, de Leon J, Chan SP, Seow SC, Kojodjojo P. Clinical Outcomes in Conduction System Pacing Compared to Right Ventricular Pacing in Bradycardia. JACC Clin Electrophysiol 2022:S2405-500X(22)00929-X. [PMID: 36752453 DOI: 10.1016/j.jacep.2022.10.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 09/06/2022] [Accepted: 10/12/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND Conduction system pacing (CSP) provides more physiological ventricular activation than right ventricular pacing (RVP). OBJECTIVES This study evaluated the differences in clinical outcomes in patients receiving CSP and RVP. METHODS Consecutive patients with pacemakers implanted for bradycardia from 2016 to 2021 in 2 centers were prospectively followed for the primary composite outcome of heart failure (HF) hospitalizations, upgrade to biventricular pacing, or all-cause mortality, stratified by ventricular pacing burden (Vp) . RESULTS Among 860 patients (mean age 74 ± 11 years, 48% female, 48% atrioventricular block), 628 received RVP and 231 received CSP (95 His-bundle pacing, 136 left bundle branch pacing). The primary outcome occurred in 217 (25%) patients, more commonly in patients with RVP than CSP (30% vs 13%, P < 0.001). In multivariable analyses, CSP was independently associated with 47% reduction of the primary outcome (adjusted hazard ratio [AHR]: 0.53; 95% CI: 0.29-0.97; P = 0.04) and HF hospitalization alone (AHR: 0.40; 95% CI: 0.17-0.95; P = 0.04), among only patients with Vp >20%. The incidence of the primary outcome was highest among RVP with Vp >20% and lowest in CSP with Vp >20% (35% vs 10%, P < 0.001). Compared with RVP with Vp >20%, both CSP with Vp >20% (AHR: 0.51; 95% CI: 0.28-0.91; P = 0.02) and all patients with Vp ≤20% (AHR: 0.73; 95% CI: 0.54-0.99; P = 0.04) were independently associated with reduced primary outcome, driven primarily by reductions in HF hospitalizations (P < 0.05). Event-free survival was similar between CSP with Vp >20% and those needing ≤20% Vp. CONCLUSIONS CSP significantly reduced adverse clinical outcomes for bradycardic patients requiring ventricular pacing and should be the preferred pacing modality of choice.
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Affiliation(s)
- Eugene S J Tan
- Department of Cardiology, National University Heart Centre, Singapore; Yong Loo Lin School of Medicine, National University Singapore, Singapore.
| | - Rodney Soh
- Department of Cardiology, National University Heart Centre, Singapore
| | - Jie-Ying Lee
- Department of Cardiology, National University Heart Centre, Singapore
| | - Elaine Boey
- Department of Cardiology, Ng Teng Fong General Hospital, Singapore
| | - Kian-Hui Ho
- Department of Cardiology, National University Heart Centre, Singapore
| | - Shana Aguirre
- Department of Cardiology, National University Heart Centre, Singapore
| | - Jhobeleen de Leon
- Department of Cardiology, National University Heart Centre, Singapore
| | - Siew-Pang Chan
- Yong Loo Lin School of Medicine, National University Singapore, Singapore
| | - Swee-Chong Seow
- Department of Cardiology, National University Heart Centre, Singapore; Yong Loo Lin School of Medicine, National University Singapore, Singapore
| | - Pipin Kojodjojo
- Department of Cardiology, National University Heart Centre, Singapore; Yong Loo Lin School of Medicine, National University Singapore, Singapore; Department of Cardiology, Ng Teng Fong General Hospital, Singapore
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Tan ES, Lee JY, Boey E, Soh R, Seow SC, Teo LJ, Yeo C, Tan VH, Kojodjojo P. Predictors of loss of capture in left bundle branch pacing: A multicenter experience. Heart Rhythm 2022; 19:1757-1758. [PMID: 35690252 DOI: 10.1016/j.hrthm.2022.06.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 05/29/2022] [Accepted: 06/02/2022] [Indexed: 11/25/2022]
Affiliation(s)
- Eugene Sj Tan
- Department of Cardiology, National University Heart Centre, Singapore; Yong Loo Lin School of Medicine, National University Singapore.
| | - Jie-Ying Lee
- Department of Cardiology, National University Heart Centre, Singapore
| | - Elaine Boey
- Department of Cardiology, Ng Teng Fong General Hospital, Singapore
| | - Rodney Soh
- Department of Cardiology, National University Heart Centre, Singapore
| | - Swee-Chong Seow
- Department of Cardiology, National University Heart Centre, Singapore; Yong Loo Lin School of Medicine, National University Singapore
| | - Lisa Jt Teo
- Department of Cardiology, Changi General Hospital, Singapore
| | - Colin Yeo
- Department of Cardiology, Changi General Hospital, Singapore
| | - Vern Hsen Tan
- Department of Cardiology, Changi General Hospital, Singapore
| | - Pipin Kojodjojo
- Department of Cardiology, National University Heart Centre, Singapore; Yong Loo Lin School of Medicine, National University Singapore; Department of Cardiology, Ng Teng Fong General Hospital, Singapore
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