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Intracardiac Echocardiography–Guided Implantation for Proximal Left Bundle Branch Pacing

Multiple screw-in attempts under fluoroscopy are often needed to place the pacing lead tip near or at the left bundle branch (LBB). This study was conducted to evaluate the feasibility of implanting an LBB pacing lead in the proximal LBB (PLBB) guided by intracardiac echocardiography (ICE). METHODS:...

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Autores principales: Kuang, XiaoHui, Zhang, Xi, Cui, YanJu, Wei, FeiYu, Wu, Peng, Gao, XiaoLong, Xiang, Hong, Wu, HaiYan, Wang, Li-Lin, Zhou, Xiaohong, Huang, Weijian, Fan, Jie
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Lippincott Williams & Wilkins 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10108837/
https://www.ncbi.nlm.nih.gov/pubmed/36924221
http://dx.doi.org/10.1161/CIRCEP.122.011408
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author Kuang, XiaoHui
Zhang, Xi
Cui, YanJu
Wei, FeiYu
Wu, Peng
Gao, XiaoLong
Xiang, Hong
Wu, HaiYan
Wang, Li-Lin
Zhou, Xiaohong
Huang, Weijian
Fan, Jie
author_facet Kuang, XiaoHui
Zhang, Xi
Cui, YanJu
Wei, FeiYu
Wu, Peng
Gao, XiaoLong
Xiang, Hong
Wu, HaiYan
Wang, Li-Lin
Zhou, Xiaohong
Huang, Weijian
Fan, Jie
author_sort Kuang, XiaoHui
collection PubMed
description Multiple screw-in attempts under fluoroscopy are often needed to place the pacing lead tip near or at the left bundle branch (LBB). This study was conducted to evaluate the feasibility of implanting an LBB pacing lead in the proximal LBB (PLBB) guided by intracardiac echocardiography (ICE). METHODS: The distribution of the LBB was initially determined by ICE anatomic imaging and 3-dimensional electrical mapping of His and LBB potentials in 20 patients in the first parts of the study. In the second part, 101 consecutive pacemaker-indicated patients were randomized into the ICE-guided and non-ICE groups for LBB pacing implantation. The procedural details and electrophysiological characteristics of the 2 groups were compared. RESULTS: In the first part of the study, PLBB was identified at 10 to 20 mm from the tricuspid annulus toward the apex with an area of 4.5±1.1 cm(2). In the second part, the number of lead screw-in attempts in the septum was fewer in the ICE group than in the non-ICE group (1.43±0.62 versus 1.98±0.75, P=0.0002). The duration of the procedure (26±8 versus 43±9 minutes, P<0.001) and fluoroscopy for LBB pacing implantation (7.4±1.8 versus 10.7±2.4 minutes, P<0.001) in the ICE group was significantly shorter than those in the non-ICE group. LBB pacing in the ICE group generated a lesser QRS duration with more cases of LBB trunk pacing (46.8% versus 25%, P=0.031) and PLBB (91.5% versus 72.7%, P=0.0267) pacing compared with that in the non-ICE group. CONCLUSIONS: The basal left ventricular septum can be better visualized using ICE. ICE-guided PLBB pacing is feasible and safe, with a shorter duration required for the procedure and fluoroscopy, and generates greater LBB trunk pacing and PLBB pacing.
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spelling pubmed-101088372023-04-18 Intracardiac Echocardiography–Guided Implantation for Proximal Left Bundle Branch Pacing Kuang, XiaoHui Zhang, Xi Cui, YanJu Wei, FeiYu Wu, Peng Gao, XiaoLong Xiang, Hong Wu, HaiYan Wang, Li-Lin Zhou, Xiaohong Huang, Weijian Fan, Jie Circ Arrhythm Electrophysiol Original Articles Multiple screw-in attempts under fluoroscopy are often needed to place the pacing lead tip near or at the left bundle branch (LBB). This study was conducted to evaluate the feasibility of implanting an LBB pacing lead in the proximal LBB (PLBB) guided by intracardiac echocardiography (ICE). METHODS: The distribution of the LBB was initially determined by ICE anatomic imaging and 3-dimensional electrical mapping of His and LBB potentials in 20 patients in the first parts of the study. In the second part, 101 consecutive pacemaker-indicated patients were randomized into the ICE-guided and non-ICE groups for LBB pacing implantation. The procedural details and electrophysiological characteristics of the 2 groups were compared. RESULTS: In the first part of the study, PLBB was identified at 10 to 20 mm from the tricuspid annulus toward the apex with an area of 4.5±1.1 cm(2). In the second part, the number of lead screw-in attempts in the septum was fewer in the ICE group than in the non-ICE group (1.43±0.62 versus 1.98±0.75, P=0.0002). The duration of the procedure (26±8 versus 43±9 minutes, P<0.001) and fluoroscopy for LBB pacing implantation (7.4±1.8 versus 10.7±2.4 minutes, P<0.001) in the ICE group was significantly shorter than those in the non-ICE group. LBB pacing in the ICE group generated a lesser QRS duration with more cases of LBB trunk pacing (46.8% versus 25%, P=0.031) and PLBB (91.5% versus 72.7%, P=0.0267) pacing compared with that in the non-ICE group. CONCLUSIONS: The basal left ventricular septum can be better visualized using ICE. ICE-guided PLBB pacing is feasible and safe, with a shorter duration required for the procedure and fluoroscopy, and generates greater LBB trunk pacing and PLBB pacing. Lippincott Williams & Wilkins 2023-03-16 /pmc/articles/PMC10108837/ /pubmed/36924221 http://dx.doi.org/10.1161/CIRCEP.122.011408 Text en © 2023 The Authors. https://creativecommons.org/licenses/by-nc-nd/4.0/Circulation: Arrhythmia and Electrophysiology is published on behalf of the American Heart Association, Inc., by Wolters Kluwer Health, Inc. This is an open access article under the terms of the Creative Commons Attribution Non-Commercial-NoDerivs (https://creativecommons.org/licenses/by-nc-nd/4.0/) License, which permits use, distribution, and reproduction in any medium, provided that the original work is properly cited, the use is noncommercial, and no modifications or adaptations are made.
spellingShingle Original Articles
Kuang, XiaoHui
Zhang, Xi
Cui, YanJu
Wei, FeiYu
Wu, Peng
Gao, XiaoLong
Xiang, Hong
Wu, HaiYan
Wang, Li-Lin
Zhou, Xiaohong
Huang, Weijian
Fan, Jie
Intracardiac Echocardiography–Guided Implantation for Proximal Left Bundle Branch Pacing
title Intracardiac Echocardiography–Guided Implantation for Proximal Left Bundle Branch Pacing
title_full Intracardiac Echocardiography–Guided Implantation for Proximal Left Bundle Branch Pacing
title_fullStr Intracardiac Echocardiography–Guided Implantation for Proximal Left Bundle Branch Pacing
title_full_unstemmed Intracardiac Echocardiography–Guided Implantation for Proximal Left Bundle Branch Pacing
title_short Intracardiac Echocardiography–Guided Implantation for Proximal Left Bundle Branch Pacing
title_sort intracardiac echocardiography–guided implantation for proximal left bundle branch pacing
topic Original Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10108837/
https://www.ncbi.nlm.nih.gov/pubmed/36924221
http://dx.doi.org/10.1161/CIRCEP.122.011408
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