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A single-centre prospective evaluation of left bundle branch area pacemaker implantation characteristics

BACKGROUND: Left bundle branch area pacing (LBBAP) has recently been introduced as a physiological pacing technique with synchronous left ventricular activation. It was our aim to evaluate the feasibility and learning curve of the technique, as well as the electrical characteristics of LBBAP. METHOD...

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Autores principales: Heckman, L. I. B., Luermans, J. G. L. M., Jastrzębski, M., Weijs, B., Van Stipdonk, A. M. W., Westra, S., den Uijl, D., Linz, D., Mafi-Rad, M., Prinzen, F. W., Vernooy, K.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Bohn Stafleu van Loghum 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9043076/
https://www.ncbi.nlm.nih.gov/pubmed/35380414
http://dx.doi.org/10.1007/s12471-022-01679-7
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author Heckman, L. I. B.
Luermans, J. G. L. M.
Jastrzębski, M.
Weijs, B.
Van Stipdonk, A. M. W.
Westra, S.
den Uijl, D.
Linz, D.
Mafi-Rad, M.
Prinzen, F. W.
Vernooy, K.
author_facet Heckman, L. I. B.
Luermans, J. G. L. M.
Jastrzębski, M.
Weijs, B.
Van Stipdonk, A. M. W.
Westra, S.
den Uijl, D.
Linz, D.
Mafi-Rad, M.
Prinzen, F. W.
Vernooy, K.
author_sort Heckman, L. I. B.
collection PubMed
description BACKGROUND: Left bundle branch area pacing (LBBAP) has recently been introduced as a physiological pacing technique with synchronous left ventricular activation. It was our aim to evaluate the feasibility and learning curve of the technique, as well as the electrical characteristics of LBBAP. METHODS AND RESULTS: LBBAP was attempted in 80 consecutive patients and electrocardiographic characteristics were evaluated during intrinsic rhythm, right ventricular septum pacing (RVSP) and LBBAP. Permanent lead implantation was successful in 77 of 80 patients (96%). LBBAP lead implantation time and fluoroscopy time shortened significantly from 33 ± 16 and 21 ± 13 min to 17 ± 5 and 12 ± 7 min, respectively, from the first 20 to the last 20 patients. Left bundle branch (LBB) capture was achieved in 54 of 80 patients (68%). In 36 of 45 patients (80%) with intact atrioventricular conduction and narrow QRS, an LBB potential (LBB(pot)) was present with an LBB(pot) to onset of QRS interval of 22 ± 6 ms. QRS duration increased significantly more during RVSP (141 ± 20 ms) than during LBBAP (125 ± 19 ms), compared to 130 ± 30 ms without pacing. An even clearer difference was observed for QRS area, which increased significantly more during RVSP (from 32 ± 16 µVs to 73 ± 20 µVs) than during LBBAP (41 ± 15 µVs). QRS area was significantly smaller in patients with LBB capture compared to patients without LBB capture (43 ± 18 µVs vs 54 ± 21 µVs, respectively). In patients with LBB capture (n = 54), the interval from the pacing stimulus to R‑wave peak time in lead V6 was significantly shorter than in patients without LBB capture (75 ± 14 vs 88 ± 9 ms, respectively). CONCLUSION: LBBAP is a safe and feasible technique, with a clear learning curve that seems to flatten after 40–60 implantations. LBB capture is achieved in two-thirds of patients. Compared to RVSP, LBBAP largely maintains ventricular electrical synchrony at a level close to intrinsic (narrow QRS) rhythm. SUPPLEMENTARY INFORMATION: The online version of this article (10.1007/s12471-022-01679-7) contains supplementary material, which is available to authorized users.
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spelling pubmed-90430762022-05-07 A single-centre prospective evaluation of left bundle branch area pacemaker implantation characteristics Heckman, L. I. B. Luermans, J. G. L. M. Jastrzębski, M. Weijs, B. Van Stipdonk, A. M. W. Westra, S. den Uijl, D. Linz, D. Mafi-Rad, M. Prinzen, F. W. Vernooy, K. Neth Heart J Original Article BACKGROUND: Left bundle branch area pacing (LBBAP) has recently been introduced as a physiological pacing technique with synchronous left ventricular activation. It was our aim to evaluate the feasibility and learning curve of the technique, as well as the electrical characteristics of LBBAP. METHODS AND RESULTS: LBBAP was attempted in 80 consecutive patients and electrocardiographic characteristics were evaluated during intrinsic rhythm, right ventricular septum pacing (RVSP) and LBBAP. Permanent lead implantation was successful in 77 of 80 patients (96%). LBBAP lead implantation time and fluoroscopy time shortened significantly from 33 ± 16 and 21 ± 13 min to 17 ± 5 and 12 ± 7 min, respectively, from the first 20 to the last 20 patients. Left bundle branch (LBB) capture was achieved in 54 of 80 patients (68%). In 36 of 45 patients (80%) with intact atrioventricular conduction and narrow QRS, an LBB potential (LBB(pot)) was present with an LBB(pot) to onset of QRS interval of 22 ± 6 ms. QRS duration increased significantly more during RVSP (141 ± 20 ms) than during LBBAP (125 ± 19 ms), compared to 130 ± 30 ms without pacing. An even clearer difference was observed for QRS area, which increased significantly more during RVSP (from 32 ± 16 µVs to 73 ± 20 µVs) than during LBBAP (41 ± 15 µVs). QRS area was significantly smaller in patients with LBB capture compared to patients without LBB capture (43 ± 18 µVs vs 54 ± 21 µVs, respectively). In patients with LBB capture (n = 54), the interval from the pacing stimulus to R‑wave peak time in lead V6 was significantly shorter than in patients without LBB capture (75 ± 14 vs 88 ± 9 ms, respectively). CONCLUSION: LBBAP is a safe and feasible technique, with a clear learning curve that seems to flatten after 40–60 implantations. LBB capture is achieved in two-thirds of patients. Compared to RVSP, LBBAP largely maintains ventricular electrical synchrony at a level close to intrinsic (narrow QRS) rhythm. SUPPLEMENTARY INFORMATION: The online version of this article (10.1007/s12471-022-01679-7) contains supplementary material, which is available to authorized users. Bohn Stafleu van Loghum 2022-04-05 2022-05 /pmc/articles/PMC9043076/ /pubmed/35380414 http://dx.doi.org/10.1007/s12471-022-01679-7 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Original Article
Heckman, L. I. B.
Luermans, J. G. L. M.
Jastrzębski, M.
Weijs, B.
Van Stipdonk, A. M. W.
Westra, S.
den Uijl, D.
Linz, D.
Mafi-Rad, M.
Prinzen, F. W.
Vernooy, K.
A single-centre prospective evaluation of left bundle branch area pacemaker implantation characteristics
title A single-centre prospective evaluation of left bundle branch area pacemaker implantation characteristics
title_full A single-centre prospective evaluation of left bundle branch area pacemaker implantation characteristics
title_fullStr A single-centre prospective evaluation of left bundle branch area pacemaker implantation characteristics
title_full_unstemmed A single-centre prospective evaluation of left bundle branch area pacemaker implantation characteristics
title_short A single-centre prospective evaluation of left bundle branch area pacemaker implantation characteristics
title_sort a single-centre prospective evaluation of left bundle branch area pacemaker implantation characteristics
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9043076/
https://www.ncbi.nlm.nih.gov/pubmed/35380414
http://dx.doi.org/10.1007/s12471-022-01679-7
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