Xi Liu1, Hong-Xia Niu1, Min Gu1, Xuhua Chen1, Yiran Hu1, Minsi Cai1, Nixiao Zhang1, Junhan Zhao1, Xiaohong Zhou2, Michael R Gold3, Wei Hua4, Shu Zhang1. 1. Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China. 2. Cardiac Rhythm and Heart Failure Division, Medtronic plc, Minneapolis, Minnesota. 3. Division of Cardiology, Medical University of South Carolina, Charleston, South Carolina. 4. Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China. Electronic address: drhuaweifw@sina.com.
Abstract
BACKGROUND: Left bundle branch pacing (LBBP) is a novel conduction system pacing modality, but pacing lead deployment remains challenging. OBJECTIVES: This study aimed to evaluate the feasibility of visualization-enhanced lead deployment for LBBP implantation and to assess LBBP characteristics on the basis of lead tip location. METHODS: Successful LBBP with a well-defined lead tip location by visualization of the tricuspid value annulus in 20 patients was retrospectively analyzed to develop an image-guided technique to identify the LBBP target site. This technique was then prospectively tested in 60 patients who were randomized into 2 groups, one using the standard approach (the standard group) and the other using the image-guided technique (the visualization group). The procedural details, electrophysiological characteristics, and short-term follow-up were compared between groups. RESULTS: LBBP was successfully achieved in 28 patients in the standard group and in 29 in the visualization group. The procedural and fluoroscopic durations in the visualization group (66.76 ± 14.62 and 7.83 ± 2.05 minutes) were significantly shorter than those in the standard group (85.46 ± 20.19 and 11.11 ± 3.51 minutes) (P < .01). The number of lead deployment attempts in the visualization group was lower than that in the standard group (2.03 ± 1.18 vs 2.96 ± 1.17; P < .01), and the proportion of left bundle branch potential recorded was higher (79.3% vs 46.4%; P = .01). CONCLUSION: Using a visualization technique, the procedural and fluoroscopic durations for LBBP implantation were significantly shortened with fewer lead repositioning attempts.
BACKGROUND: Left bundle branch pacing (LBBP) is a novel conduction system pacing modality, but pacing lead deployment remains challenging. OBJECTIVES: This study aimed to evaluate the feasibility of visualization-enhanced lead deployment for LBBP implantation and to assess LBBP characteristics on the basis of lead tip location. METHODS: Successful LBBP with a well-defined lead tip location by visualization of the tricuspid value annulus in 20 patients was retrospectively analyzed to develop an image-guided technique to identify the LBBP target site. This technique was then prospectively tested in 60 patients who were randomized into 2 groups, one using the standard approach (the standard group) and the other using the image-guided technique (the visualization group). The procedural details, electrophysiological characteristics, and short-term follow-up were compared between groups. RESULTS: LBBP was successfully achieved in 28 patients in the standard group and in 29 in the visualization group. The procedural and fluoroscopic durations in the visualization group (66.76 ± 14.62 and 7.83 ± 2.05 minutes) were significantly shorter than those in the standard group (85.46 ± 20.19 and 11.11 ± 3.51 minutes) (P < .01). The number of lead deployment attempts in the visualization group was lower than that in the standard group (2.03 ± 1.18 vs 2.96 ± 1.17; P < .01), and the proportion of left bundle branch potential recorded was higher (79.3% vs 46.4%; P = .01). CONCLUSION: Using a visualization technique, the procedural and fluoroscopic durations for LBBP implantation were significantly shortened with fewer lead repositioning attempts.
Authors: Xi Liu; Min Gu; Hong-Xia Niu; Xuhua Chen; Chi Cai; Junhan Zhao; Minsi Cai; Xiaohong Zhou; Michael R Gold; Shu Zhang; Wei Hua Journal: Front Cardiovasc Med Date: 2022-01-05