Junmeng Zhang1, Zefeng Wang2, Linna Zu1, Liting Cheng1, Ruijuan Su3, Xinlu Wang1, Zhuo Liang1, Jieruo Chen1, Fei Hang1, Jie Du4, Weijian Huang5, Yongquan Wu6. 1. Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China. 2. Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China; Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China. 3. Department of Ultrasound, Beijing Jishuitan Hospital, Beijing, China. 4. Beijing Anzhen Hospital, Capital Medical University, Beijing, China; The Key Laboratory of Remodeling-Related Cardiovascular Diseases, Capital Medical University, Ministry of Education, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China. 5. Department of Cardiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou. 6. Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China. Electronic address: wuyongquan67@163.com.
Abstract
BACKGROUND: Left bundle branch area pacing (LBBaP) is accepted as a physiological form of pacing; however, it is complex and usually requires an expensive electrophysiological recording system. METHODS: A simplified approach ("9-partition method") was explored to perform LBBaP. In this method, a right anterior oblique 30° fluoroscopic image of the ventricle was divided into 9 sections ("3 × 3" partitions). From May 2018 to February 2019, we enrolled 51 consecutive patients who underwent pacemaker implantation. The patients were nonrandomly allocated to either the conventional LBBaP (c-LBBaP) group or simplified LBBaP (s-LBBaP) group. RESULTS: The mean age was 68.53 ± 11.90 years, and 32 (62.7%) patients were male. The overall success rate was 90.2% (46/51). Compared with the c-LBBaP group, the s-LBBaP group had a significantly lower total procedure duration (91.57 ± 19.51 minutes vs 70.68 ± 13.26 minutes; P < 0.001) and fluoroscopy duration (16.52 ± 5.34 minutes vs 10.54 ± 3.13 minutes; P < 0.001). The time from the 3830 lead and sheath passage through the tricuspid valve to an acceptable initial fixation site (4.69 ± 1.61 minutes vs 2.75 ± 1.04 minutes; P < 0.001) and the time to the left bundle branch lead being implanted successfully (11.78 ± 3.00 minutes vs 7.67 ± 2.45 minutes; P < 0.001) for the c-LBBaP vs s-LBBaP groups, respectively, were significantly different. After 3 months, there were no significant differences in the capture threshold, R wave amplitude, impedance, or QRS duration between the groups. CONCLUSIONS: Compared with the c-LBBaP approach, our simplified 9-partition method was faster and did not require an expensive electrophysiological recording system.
BACKGROUND:Left bundle branch area pacing (LBBaP) is accepted as a physiological form of pacing; however, it is complex and usually requires an expensive electrophysiological recording system. METHODS: A simplified approach ("9-partition method") was explored to perform LBBaP. In this method, a right anterior oblique 30° fluoroscopic image of the ventricle was divided into 9 sections ("3 × 3" partitions). From May 2018 to February 2019, we enrolled 51 consecutive patients who underwent pacemaker implantation. The patients were nonrandomly allocated to either the conventional LBBaP (c-LBBaP) group or simplified LBBaP (s-LBBaP) group. RESULTS: The mean age was 68.53 ± 11.90 years, and 32 (62.7%) patients were male. The overall success rate was 90.2% (46/51). Compared with the c-LBBaP group, the s-LBBaP group had a significantly lower total procedure duration (91.57 ± 19.51 minutes vs 70.68 ± 13.26 minutes; P < 0.001) and fluoroscopy duration (16.52 ± 5.34 minutes vs 10.54 ± 3.13 minutes; P < 0.001). The time from the 3830 lead and sheath passage through the tricuspid valve to an acceptable initial fixation site (4.69 ± 1.61 minutes vs 2.75 ± 1.04 minutes; P < 0.001) and the time to the left bundle branch lead being implanted successfully (11.78 ± 3.00 minutes vs 7.67 ± 2.45 minutes; P < 0.001) for the c-LBBaP vs s-LBBaP groups, respectively, were significantly different. After 3 months, there were no significant differences in the capture threshold, R wave amplitude, impedance, or QRS duration between the groups. CONCLUSIONS: Compared with the c-LBBaP approach, our simplified 9-partition method was faster and did not require an expensive electrophysiological recording system.