Matthew Bocchese1, Michael Gannon2, Pravin Patil2, William Van Decker2, Isaac R Whitman2, Edmond M Cronin2. 1. Department of Medicine, Section of Cardiology, Lewis Katz School of Medicine, Temple University Hospital, 3401 N. Broad St., Parkinson Pavilion, 9th Floor, PA, 19140, Philadelphia, USA. Matthew.bocchese@tuhs.temple.edu. 2. Department of Medicine, Section of Cardiology, Lewis Katz School of Medicine, Temple University Hospital, 3401 N. Broad St., Parkinson Pavilion, 9th Floor, PA, 19140, Philadelphia, USA.
Abstract
BACKGROUND: Left bundle branch pacing (LBBP) is a developing method of native conduction pacing, but cases of injury to the septal perforator arteries during implantation have been reported. Knowing the distance between the His bundle and the first septal perforator artery can help operators implant LBBP leads more safely. METHODS: Using previously performed coronary CT angiography (CCTA) studies, the distance between the His bundle and the first septal perforator was measured. RESULTS: A total of 50 CCTA studies were included. The mean distance from the His bundle to the first septal perforator (His-SP) along the line connecting the His bundle to the RV apex (His-RV apex) was 27.17 ± 7.7 mm with a range of 13.0 to 44.7 mm. The distance was greater than 2.0 cm in 84% of patients. To standardize this distance among patients with varying cardiac structures, the ratio between the His-SP distance and the His-RV Apex distance was also measured. The mean His-SP:His-RV Apex was 0.302 and the median was 0.298. Eighty-six percent of patients had a ratio of greater than 0.20. CONCLUSION: Using this information, operators can aim to implant LBBP leads within 2.0 cm of the His bundle or 20% of the distance between the His bundle and the RV apex with minimal risk of causing vascular injury.
BACKGROUND: Left bundle branch pacing (LBBP) is a developing method of native conduction pacing, but cases of injury to the septal perforator arteries during implantation have been reported. Knowing the distance between the His bundle and the first septal perforator artery can help operators implant LBBP leads more safely. METHODS: Using previously performed coronary CT angiography (CCTA) studies, the distance between the His bundle and the first septal perforator was measured. RESULTS: A total of 50 CCTA studies were included. The mean distance from the His bundle to the first septal perforator (His-SP) along the line connecting the His bundle to the RV apex (His-RV apex) was 27.17 ± 7.7 mm with a range of 13.0 to 44.7 mm. The distance was greater than 2.0 cm in 84% of patients. To standardize this distance among patients with varying cardiac structures, the ratio between the His-SP distance and the His-RV Apex distance was also measured. The mean His-SP:His-RV Apex was 0.302 and the median was 0.298. Eighty-six percent of patients had a ratio of greater than 0.20. CONCLUSION: Using this information, operators can aim to implant LBBP leads within 2.0 cm of the His bundle or 20% of the distance between the His bundle and the RV apex with minimal risk of causing vascular injury.
Authors: Louisa O'Neill; Iain Sim; Daniel O'Hare; John Whitaker; Rahul K Mukherjee; Steven Niederer; Matthew Wright; Vivienne Ezzat; Eric Rosenthal; Matthew I Jones; Alessandra Frigiola; Mark D O'Neill; Steven E Williams Journal: J Interv Card Electrophysiol Date: 2022-06-23 Impact factor: 1.759