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Molina-Lerma M, Cabrera-Borrego E, Rivera-Lopez R, Sánchez-Millán P, Peña Mellado J, Arriaga Jiménez A, Álvarez M. Comparison of automated subcutaneous defibrillator screening between different pacing sites in cardiac pacing device carriers. Europace 2023; 25:euad352. [PMID: 38019960 PMCID: PMC10751811 DOI: 10.1093/europace/euad352] [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] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 09/19/2023] [Accepted: 11/22/2023] [Indexed: 12/01/2023] Open
Abstract
AIMS The compatibility of cardiac pacing with the presence of a subcutaneous implantable cardioverter-defibrillator (S-ICD) has been investigated, but S-ICD screening test results have not been compared among different pacing sites. The objective was to compare S-ICD screening results among different cardiac pacing sites and to assess the electrocardiographic predictors of success. METHODS AND RESULTS This prospective single-centre study conducted automated S-ICD screening in 102 carriers of cardiac pacing devices in conduction system (CSP), biventricular (BVP), right ventricular outflow tract (RVOT), or right ventricular apex (RVA) pacing sites. The study included 102 patients: 40 with CSP (20 left bundle pacing and 20 His bundle pacing), 21 with BVP, and 20 and 21 with RVOT and RVA pacing, respectively. The percentage of positive screenings was significantly higher for CSP (97.5%) than for the other patient groups (BVP 71.4%, RVOT 70%, and RVA 19%). In multivariate analysis, positive screening was associated with a narrower QRS (OR 0.95 [0.92-0.98] P = 0.001) and higher R/T ratio in precordial leads (1.76 [1.18-2.61]). CONCLUSION A higher S-ICD eligibility rate of cardiac pacing device carriers was obtained in CSP than in conventional pacing (RVA or RVOT) or BVP. The presence of narrower paced QRS width and paced corrected QT interval and of higher R/T ratio in precordial and limb leads are electrocardiographic predictors of a positive response to screening.
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Affiliation(s)
- Manuel Molina-Lerma
- Arrhythmia Unit, Hospital Universitario Virgen de las Nieves, Avenida de las Fuerzas Armadas, 18014 Granada, Spain
- Biohealth Research Institute ibs. GRANADA, Av. de Madrid, 15, 18012 Granada, Spain
| | - Eva Cabrera-Borrego
- Arrhythmia Unit, Hospital Universitario Virgen de las Nieves, Avenida de las Fuerzas Armadas, 18014 Granada, Spain
- Biohealth Research Institute ibs. GRANADA, Av. de Madrid, 15, 18012 Granada, Spain
| | - Ricardo Rivera-Lopez
- Arrhythmia Unit, Hospital Universitario Virgen de las Nieves, Avenida de las Fuerzas Armadas, 18014 Granada, Spain
- Biohealth Research Institute ibs. GRANADA, Av. de Madrid, 15, 18012 Granada, Spain
| | - Pablo Sánchez-Millán
- Arrhythmia Unit, Hospital Universitario Virgen de las Nieves, Avenida de las Fuerzas Armadas, 18014 Granada, Spain
- Biohealth Research Institute ibs. GRANADA, Av. de Madrid, 15, 18012 Granada, Spain
| | - Jesús Peña Mellado
- Arrhythmia Unit, Hospital Universitario Virgen de las Nieves, Avenida de las Fuerzas Armadas, 18014 Granada, Spain
- Biohealth Research Institute ibs. GRANADA, Av. de Madrid, 15, 18012 Granada, Spain
| | - Antonio Arriaga Jiménez
- Arrhythmia Unit, Hospital Universitario Virgen de las Nieves, Avenida de las Fuerzas Armadas, 18014 Granada, Spain
- Biohealth Research Institute ibs. GRANADA, Av. de Madrid, 15, 18012 Granada, Spain
| | - Miguel Álvarez
- Arrhythmia Unit, Hospital Universitario Virgen de las Nieves, Avenida de las Fuerzas Armadas, 18014 Granada, Spain
- Biohealth Research Institute ibs. GRANADA, Av. de Madrid, 15, 18012 Granada, Spain
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Vajapey R, Amuthan R, Chung M, Tchou P, Rickard J, Chung R, Varma N, Niebauer M. High predictive value of paced QRS frequency in verification of left bundle branch pacing. J Interv Card Electrophysiol 2023; 66:2041-2046. [PMID: 37014480 PMCID: PMC10548354 DOI: 10.1007/s10840-023-01541-9] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 03/27/2023] [Indexed: 04/05/2023]
Abstract
BACKGROUND Left bundle branch area pacing (LBBAP) is a newer technique to deliver more synchronous left ventricular activation. Several criteria have been proposed, but not fully validated, to confirm LBBAP during implantation of the pacing lead. Spectral analysis has been used to characterize the frequency components of the clinical QRS utilizing the Fourier transform algorithm. We hypothesized that higher frequency content of the paced QRS complex may show predictive value of successful LBBAP. METHODS We evaluated 84 patients with ejection fraction > 50%, who underwent LBB lead placement (n = 42) using ≥ 1 current criteria and right ventricular midseptal (RVsp) lead placement (n = 42) from 2000 to 2022. Time frequency analysis (Matlab) was used to determine the frequency content of the paced QRS complex. The centroid frequency (CF), which is the weighted average QRS frequency, was calculated. RESULTS Patients in RVsp group had a longer paced QRS duration (155.6 ± 28.0 vs 127.1 ± 17.2, p < 0.002) compared to the LBBAP group. Of all standard ECG leads, the paced QRS in V2 gave the greatest difference of the CF of the LBBAP group at 8.8 ± 1.6 Hz versus 5.7 ± 0.7 Hz of the RVsp group. This difference was significant by both univariate (p < 0.003) and multivariate (p < 0.010) analysis. Predictive value of the CF for successful LBB pacing in lead V2 was highest with an AUC of 0.98. The sensitivity and specificity were 88.1% and 97.6%, respectively. CONCLUSION Spectral analysis predicts successful LBBAP with higher frequency content when compared to RVsp pacing. Given the limitations to the current criteria to confirm LBBAP, intraprocedural use of frequency content analysis of the paced QRS complex in patients may prove useful at verifying LBB capture if verified by prospective clinical trials.
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Affiliation(s)
- Ramya Vajapey
- Cleveland Clinic Foundation, Cleveland, OH, 44195, USA.
| | - Ram Amuthan
- Case Western Reserve University, Cleveland, OH, 44106, USA
| | - Mina Chung
- Cleveland Clinic Foundation, Cleveland, OH, 44195, USA
| | - Patrick Tchou
- Cleveland Clinic Foundation, Cleveland, OH, 44195, USA
| | - John Rickard
- Cleveland Clinic Foundation, Cleveland, OH, 44195, USA
| | - Roy Chung
- Cleveland Clinic Foundation, Cleveland, OH, 44195, USA
| | - Niraj Varma
- Cleveland Clinic Foundation, Cleveland, OH, 44195, USA
| | - Mark Niebauer
- Cleveland Clinic Foundation, Cleveland, OH, 44195, USA
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Vadivelu R, Shunmugasundaram P, Murugan S, Lokhandwala Y. Helix un-winding of lumenless lead during attempted left bundle branch area pacing. Indian Pacing Electrophysiol J 2023; 23:218-220. [PMID: 37716595 PMCID: PMC10685100 DOI: 10.1016/j.ipej.2023.09.003] [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] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 08/26/2023] [Accepted: 09/12/2023] [Indexed: 09/18/2023] Open
Affiliation(s)
- Ramalingam Vadivelu
- Department of Cardiology, Velammal Medical College Hospital and Research Institute, Madurai, India.
| | | | - Senthil Murugan
- Department of Cardiology, Velammal Medical College Hospital and Research Institute, Madurai, India
| | - Yash Lokhandwala
- Department of Cardiology, Bandra Holy Family Hospital and Research Institute, India
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Strocchi M, Wijesuriya N, Mehta V, de Vere F, Rinaldi CA, Niederer SA. Computational Modelling Enabling In Silico Trials for Cardiac Physiologic Pacing. J Cardiovasc Transl Res 2023:10.1007/s12265-023-10453-y. [PMID: 37870689 DOI: 10.1007/s12265-023-10453-y] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 10/10/2023] [Indexed: 10/24/2023]
Abstract
Conduction system pacing (CSP) has the potential to achieve physiological-paced activation by pacing the ventricular conduction system. Before CSP is adopted in standard clinical practice, large, randomised, and multi-centre trials are required to investigate CSP safety and efficacy compared to standard biventricular pacing (BVP). Furthermore, there are unanswered questions about pacing thresholds required to achieve optimal pacing delivery while preventing device battery draining, and about which patient groups are more likely to benefit from CSP rather than BVP. In silico studies have been increasingly used to investigate mechanisms underlying changes in cardiac function in response to pathologies and treatment. In the context of CSP, they have been used to improve our understanding of conduction system capture to optimise CSP delivery and battery life, and noninvasively compare different pacing methods on different patient groups. In this review, we discuss the in silico studies published to date investigating different aspects of CSP delivery.
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Affiliation(s)
- Marina Strocchi
- National Heart and Lung Institute, Imperial College London, 72 Du Cane Road, W12 0HS, London, UK.
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK.
| | - Nadeev Wijesuriya
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Vishal Mehta
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Felicity de Vere
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Christopher A Rinaldi
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Steven A Niederer
- National Heart and Lung Institute, Imperial College London, 72 Du Cane Road, W12 0HS, London, UK
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
- The Alan Turing Institute, London, UK
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Simader F, Arnold A, Whinnett Z. Comparison of methods for delivering cardiac resynchronization therapy: electrical treatment targets and mechanisms of action. Expert Rev Med Devices 2023; 20:337-348. [PMID: 37071055 DOI: 10.1080/17434440.2023.2199925] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
Abstract
INTRODUCTION Cardiac resynchronization therapy (CRT) has been developed as a treatment for patients with conduction system dysfunction and impairment of ventricular performance. The aim is to restore more physiological cardiac activation and thereby improve cardiac function, symptoms, and outcomes. AREAS COVERED In this review, we discuss potential electrical treatment targets for patients with heart failure and how these electrical treatment targets may determine the optimal pacing approach for delivering CRT. EXPERT OPINION The most well-established method for delivering CRT is biventricular pacing (BVP). BVP improves symptoms and reduces mortality in patients with left bundle branch block (LBBB). However, patients continue to suffer from heart failure symptoms and decompensations despite receiving BVP. There may be scope to deliver more effective CRT since BVP does not restore physiological ventricular activation. Furthermore, the results with BVP in patients with non-LBBB conduction system disease have been generally disappointing. Alternative pacing approaches to BVP are now available, including conduction system pacing and left ventricular endocardial pacing. These newer pacing approaches offer exciting potential to not only offer an alternative to coronary sinus lead implantation in the case of implant failure but to potentially deliver more effective treatment in LBBB and maybe even extend the indications for CRT beyond LBBB.
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Affiliation(s)
- Florentina Simader
- National Heart and Lung Institute, Imperial College London, Hammersmith Hospital, London, UK
| | - Ahran Arnold
- National Heart and Lung Institute, Imperial College London, Hammersmith Hospital, London, UK
| | - Zachary Whinnett
- National Heart and Lung Institute, Imperial College London, Hammersmith Hospital, London, UK
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O'Connor M, Shi R, Kramer DB, Riad O, Hunnybun D, Jarman JW, Foran J, Cantor E, Markides V, Wong T. Conduction system pacing learning curve: Left bundle pacing compared to His bundle pacing. Int J Cardiol Heart Vasc 2023; 44:101171. [PMID: 36660200 PMCID: PMC9843166 DOI: 10.1016/j.ijcha.2023.101171] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 01/04/2023] [Indexed: 01/12/2023]
Abstract
Introduction Conduction system pacing (CSP), consisting of His bundle pacing (HBP) or left bundle branch area pacing (LBBAP) is a rapidly developing field. These pacing techniques result in single lead left ventricular resynchronisation. Understanding of the associated learning curve of the two techniques is an important consideration for new implanters/implanting centres. Methods We conducted a review of the first 30 cases of both HBP and LBBAP at The Royal Brompton Hospital. The procedural duration and fluoroscopy time were used as surrogates for the learning curve of each technique. Results Patient characteristics were similar in HBP and LBBAP groups; LV ejection fraction (46% vs 54%, p = 0.08), pre-procedural QRS duration (119 ms vs 128 ms, p = 0.32).Mean procedural duration was shorter for LBBAP than for HBP (87 vs 107mins, p = 0.04) and the drop in procedural duration was more marked in LBBAP, plateauing and remaining low at 80mins after the initial 10 cases. Fluoroscopic screening time mirrored procedural duration (8 min vs 16 min, p < 0.01). Discussion/Conclusion Our data suggest that the CSP learning curve was shorter for LBBAP than for HBP and appears to plateaux after the first 10 cases, however the HBP learning curve is longer with continued improvement over the first 30 cases. The shorter learning curve of LBBAP in conjunction with the superior electrical parameters and simplified programming mean the establishment of a CSP program is potentially easier with LBBAP compared to with HBP.
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Affiliation(s)
- Matthew O'Connor
- Heart Rhythm Centre, The Royal Brompton and Harefield NHS Foundation Trust, Guys & St Thomas' NHS Foundation Trust, UK,Department of Electrophysiology, Auckland City Hospital, New Zealand
| | - Rui Shi
- Heart Rhythm Centre, The Royal Brompton and Harefield NHS Foundation Trust, Guys & St Thomas' NHS Foundation Trust, UK
| | - Daniel B. Kramer
- Heart Rhythm Centre, The Royal Brompton and Harefield NHS Foundation Trust, Guys & St Thomas' NHS Foundation Trust, UK,Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Omar Riad
- Heart Rhythm Centre, The Royal Brompton and Harefield NHS Foundation Trust, Guys & St Thomas' NHS Foundation Trust, UK
| | - Daniel Hunnybun
- Heart Rhythm Centre, The Royal Brompton and Harefield NHS Foundation Trust, Guys & St Thomas' NHS Foundation Trust, UK
| | - Julian W.E. Jarman
- Heart Rhythm Centre, The Royal Brompton and Harefield NHS Foundation Trust, Guys & St Thomas' NHS Foundation Trust, UK
| | - John Foran
- Heart Rhythm Centre, The Royal Brompton and Harefield NHS Foundation Trust, Guys & St Thomas' NHS Foundation Trust, UK
| | - Emily Cantor
- Heart Rhythm Centre, The Royal Brompton and Harefield NHS Foundation Trust, Guys & St Thomas' NHS Foundation Trust, UK
| | - Vias Markides
- Heart Rhythm Centre, The Royal Brompton and Harefield NHS Foundation Trust, Guys & St Thomas' NHS Foundation Trust, UK
| | - Tom Wong
- Heart Rhythm Centre, The Royal Brompton and Harefield NHS Foundation Trust, Guys & St Thomas' NHS Foundation Trust, UK,Kings College Hospital, London, UK,National Heart & Lung Institute, Imperial College, London, UK,Corresponding author at: Heart Rhythm Centre, The Royal Brompton and Harefield NHS Foundation Trust, Guys & St Thomas' NHS Foundation Trust, Sydney Street, London SW3 6NP, UK.
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O’Connor M, Riad O, Shi R, Hunnybun D, Li W, Jarman JWE, Foran J, Rinaldi CA, Markides V, Gatzoulis MA, Wong T. Left bundle branch area pacing in congenital heart disease. Europace 2022; 25:561-570. [PMID: 36358001 PMCID: PMC9935007 DOI: 10.1093/europace/euac175] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 09/08/2022] [Indexed: 11/12/2022] Open
Abstract
AIMS Left bundle branch area pacing (LBBAP) has been shown to be effective and safe. Limited data are available on LBBAP in the congenital heart disease (CHD) population. This study aims to describe the feasibility and safety of LBBAP in CHD patients compared with non-CHD patients. METHODS AND RESULTS This is a single-centre, non-randomized observational study recruiting consecutive patients with bradycardia indication. Demographic data, ECGs, imaging, and procedural data including lead parameters were recorded. A total of 39 patients were included: CHD group (n = 13) and non-CHD group (n = 26). Congenital heart disease patients were younger (55 ± 14.5 years vs. 73.2 ± 13.1, P < 0.001). Acute success was achieved in all CHD patients and 96% (25/26) of non-CHD patients. No complications were encountered in either group. The procedural time for CHD patients was comparable (96.4 ± 54 vs. 82.1 ± 37.9 min, P = 0.356). Sheath reshaping was required in 7 of 13 CHD patients but only in 1 of 26 non-CHD patients, reflecting the complex and distorted anatomy of the patients in this group. Lead parameters were similar in both groups; R wave (11 ± 7 mV vs. 11.5 ± 7.5, P = 0.881) and pacing threshold (0.6 ± 0.3 V vs. 0.7 ± 0.3, P = 0.392). Baseline QRS duration was longer in the CHD group (150 ± 28.2 vs. 118.6 ± 26.6 ms, P = 0.002). Despite a numerically greater reduction in QRS and a similar left ventricular activation time (65.9 ± 6.2 vs. 67 ± 16.8 ms, P = 0.840), the QRS remained longer in the CHD group (135.5 ± 22.4 vs. 106.9 ± 24.7 ms, P = 0.005). CONCLUSION Left bundle branch area pacing is feasible and safe in CHD patients as compared to that in non-CHD patients. Procedural and fluoroscopy times did not differ between both groups. Lead parameters were satisfactory and stable over a short-term follow-up.
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Affiliation(s)
| | | | - Rui Shi
- Heart Rhythm Centre, Royal Brompton and Harefield Hospitals, Guy’s and St Thomas’ NHS Foundation Trust, London SW3 6NP, UK
| | - Dan Hunnybun
- Heart Rhythm Centre, Royal Brompton and Harefield Hospitals, Guy’s and St Thomas’ NHS Foundation Trust, London SW3 6NP, UK
| | - Wei Li
- Heart Rhythm Centre, Royal Brompton and Harefield Hospitals, Guy’s and St Thomas’ NHS Foundation Trust, London SW3 6NP, UK,Adult Congenital Heart Centre, Royal Brompton and Harefield Hospitals, Guy’s and St Thomas’ NHS Foundation Trust, Sydney Street, London SW3 6NP, UK
| | - Julian W E Jarman
- Heart Rhythm Centre, Royal Brompton and Harefield Hospitals, Guy’s and St Thomas’ NHS Foundation Trust, London SW3 6NP, UK,Adult Congenital Heart Centre, Royal Brompton and Harefield Hospitals, Guy’s and St Thomas’ NHS Foundation Trust, Sydney Street, London SW3 6NP, UK
| | - John Foran
- Heart Rhythm Centre, Royal Brompton and Harefield Hospitals, Guy’s and St Thomas’ NHS Foundation Trust, London SW3 6NP, UK
| | | | - Vias Markides
- Heart Rhythm Centre, Royal Brompton and Harefield Hospitals, Guy’s and St Thomas’ NHS Foundation Trust, London SW3 6NP, UK
| | - Michael A Gatzoulis
- Adult Congenital Heart Centre, Royal Brompton and Harefield Hospitals, Guy’s and St Thomas’ NHS Foundation Trust, Sydney Street, London SW3 6NP, UK,National Heart & Lung Institute, Imperial College, London SW3 6LY, UK
| | - Tom Wong
- Corresponding author. Tel: +44 20 7352 8121; fax: +44 20 7351 8699. E-mail address:
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Abstract
Left bundle branch pacing (LBBP) is emerging as an alternative to His bundle pacing that overcomes the latter’s limitations. Several studies have reported on the safety, efficacy, and electrophysiological properties of LBBP, while postoperative success rates range from 80.5% to 94%. The left posterior fascicle is composed of broad bands of fibers coursing inferiorly and posteriorly toward the papillary muscle, while the anterior fascicle is a thin, tendon-like structure. We report a case of a 70-year-old man in whom left posterior fascicular pacing was done after LBBP failed. We were able to demonstrate all the features of left posterior fascicular capture, including fascicular potential and a left anterior hemiblock pattern, using surface 12-lead electrocardiography. Left posterior fascicular pacing could be an alternative technique when attempts to deploy LBBP fail.
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Affiliation(s)
- Shunmuga Sundaram Ponnusamy
- Department of Cardiology, Velammal Medical College Hospital and Research Institute, Madurai, Tamil Nadu, India
| | - Thabish Syed
- Department of Cardiology, Velammal Medical College Hospital and Research Institute, Madurai, Tamil Nadu, India
| | - Surya Kumar
- Department of Cardiology, Velammal Medical College Hospital and Research Institute, Madurai, Tamil Nadu, India
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Affiliation(s)
- Shunumuga Sundaram Ponnusamy
- Department of Cardiology, Velammal Medical College Hospital and Research Institute, Madurai, India
- Geisinger Commonwealth School of Medicine, Wilkes-Barre, Pennsylvania
| | - Pugazhendhi Vijayaraman
- Address reprint requests and correspondence: Dr Pugazhendhi Vijayaraman, Professor of Medicine, Geisinger Commonwealth School of Medicine, Geisinger Heart Institute, MC 36-10, 1000 E Mountain Blvd, Wilkes-Barre, PA 18711.
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Ponnusamy SS, Muthu G, Kumar M, Bopanna D, Anand V, Kumar S. Mid-term feasibility, safety and outcomes of left bundle branch pacing-single center experience. J Interv Card Electrophysiol 2020; 60:337-346. [PMID: 32623624 DOI: 10.1007/s10840-020-00807-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [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: 04/28/2020] [Accepted: 06/22/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND His bundle pacing (HBP) has evolved as the most physiological form of pacing but associated with limitations. Recently, left bundle branch pacing (LBBP) is emerging as an effective alternative strategy for HBP. OBJECTIVES Our study was designed to assess the feasibility, efficacy, electrophysiological parameters, and mid-term outcomes of LBBP in Indian population. METHODS All patients requiring permanent pacemaker implantation for symptomatic bradycardia and heart failure were prospectively enrolled. Echocardiography, QRS duration, pacing parameters, left bundle (LB) potentials, paced QRS duration, and peak left ventricular activation time (pLVAT) were recorded. RESULTS LBBP was successful in 93 out of 99 patients (94% acute success). Mean age was 62.6 ± 13 years, male 59%, diabetes 69%, and coronary artery disease 65%. Follow-up duration was 4.8 months (range1-12 months). Indication for pacing included atrioventricular (AV) block 43%, cardiac resynchronization therapy 44%, and AV node ablation 4%. LB potential was noted in 37 patients (40%). QRS duration reduced from 144.38 ± 34.6 at baseline to 110.8 ± 12.4 ms after LBBP (p < 0.0001). Pacing threshold was 0.59 ± 0.22 V and sensed R wave 14.14 ± 7.19 mV, and it remained stable during follow-up. Lead depth in the septum was 9.62 mm. LV ejection fraction increased from 44.96 to 53.3% after LBBP (p < 0.0001). One died due to respiratory tract infection on follow up. CONCLUSION LBBP is a safe and effective strategy (94% acute success) of physiological pacing. The pacing parameters remained stable over a period of 12 months follow-up. LBBP can effectively overcome the limitations of HBP.
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Affiliation(s)
- Shunmuga Sundaram Ponnusamy
- Department of Cardiology, Velammal Medical College Hospital and Research Institute, Velammal Village, Airport ring road, Madurai, Tamilnadu, 625009, India.
| | - Giridhar Muthu
- Department of Cardiology, Velammal Medical College Hospital and Research Institute, Velammal Village, Airport ring road, Madurai, Tamilnadu, 625009, India
| | - Mahesh Kumar
- Department of Cardiology, Velammal Medical College Hospital and Research Institute, Velammal Village, Airport ring road, Madurai, Tamilnadu, 625009, India
| | - Dasarath Bopanna
- Department of Cardiology, Velammal Medical College Hospital and Research Institute, Velammal Village, Airport ring road, Madurai, Tamilnadu, 625009, India
| | - Vijesh Anand
- Department of Cardiology, Velammal Medical College Hospital and Research Institute, Velammal Village, Airport ring road, Madurai, Tamilnadu, 625009, India
| | - Surya Kumar
- Department of Cardiology, Velammal Medical College Hospital and Research Institute, Velammal Village, Airport ring road, Madurai, Tamilnadu, 625009, India
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Ponnusamy SS, Muthu G, Bopanna D. Selective left bundle branch pacing for pediatric complete heart block. Indian Pacing Electrophysiol J 2019; 20:78-80. [PMID: 31866553 PMCID: PMC7082648 DOI: 10.1016/j.ipej.2019.12.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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] [Received: 10/28/2019] [Revised: 12/15/2019] [Accepted: 12/15/2019] [Indexed: 11/26/2022] Open
Abstract
Traditionally Right Ventricle has been the preferred site of pacing for the management of symptomatic brady-arrhythmias. The deleterious effect of chronic RV pacing has been shown by several studies. This has generated interest into a novel pacing strategy called physiological pacing wherein the His bundle or the left bundle is paced directly with 4.1 F pacing lead. Herewith we are reporting a case of congenital complete heart block in a 13-year-old child for whom selective left bundle branch pacing was done. This physiological pacing will ensure a synchronized contraction of the ventricles thereby avoiding the deleterious effect of RV pacing.
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Affiliation(s)
| | - Giridhar Muthu
- Department of Cardiology, Velammal Medical College Hospital and Research Institute, Madurai, India
| | - Dasarath Bopanna
- Department of Cardiology, Velammal Medical College Hospital and Research Institute, Madurai, India
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12
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Abstract
BACKGROUND His-bundle pacing is an emerging routine technique that avoids pacing-dependent side effects. However, the success rate of His-bundle pacing is not 100%.Methods and Results:Left bundle pacing or peri-left bundle pacing (LBP/peri-LBP) are recently developed techniques that directly capture the left bundle or ventricular tissue near the left bundle. We evaluated the success rate of LBP/peri-LBP in patients whose treatment with His-bundle pacing failed. In addition, we evaluated left ventricular contraction and desynchrony after LBP/peri-LBP. CONCLUSIONS LBP/peri-LBP is an alternative ventricular pacing method in atrioventricular block in patients with failure of His-bundle pacing.
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Affiliation(s)
- Eriko Hasumi
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo.,Department of Ubiquitous Health Informatics, Graduate School of Medicine, The University of Tokyo
| | - Katsuhito Fujiu
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo.,Department of Advanced Cardiology, Graduate School of Medicine, The University of Tokyo
| | - Koki Nakanishi
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
| | - Issei Komuro
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
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