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His Bundle and Left Bundle Branch Pacing: Initial experience
Session:
Posters (Sessão 3 - Écran 2) - Arritmias 3 - Vários
Speaker:
Carolina Saleiro
Congress:
CPC 2022
Topic:
C. Arrhythmias and Device Therapy
Theme:
09. Device Therapy
Subtheme:
09.1 Antibradycardia Pacing
Session Type:
Pósters Electrónicos
FP Number:
---
Authors:
Carolina Saleiro; Pedro a. Sousa; Catarina Nogueira; Lídia Mota; Cláudia Almeida; Gisela Bragança; Francisco Paisana
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:black"><strong><span style="font-size:10.0pt"><span style="font-family:"Arial",sans-serif">Background:</span></span></strong> <span style="font-size:10.0pt"><span style="font-family:"Arial",sans-serif"><span style="color:black">Right ventricular apical pacing </span></span></span><span style="font-size:10.0pt"><span style="font-family:"Arial",sans-serif">is associated to </span></span><span style="font-size:10.0pt"><span style="font-family:"Arial",sans-serif"><span style="color:black">electric and mechanical desynchrony. Recently, t</span></span></span><span style="font-size:10.0pt"><span style="font-family:"Arial",sans-serif">here has been increasing interest in pacing methods that provides physiological stimulation directly activating the conduction system, such as, His bundle pacing (HBP) or left bundle branch pacing (LBBP). </span></span></span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:black"><strong><span style="font-size:10.0pt"><span style="font-family:"Arial",sans-serif">Aim: </span></span></strong><span style="font-size:10.0pt"><span style="font-family:"Arial",sans-serif">To</span></span><span style="font-size:10.0pt"><span style="font-family:"Arial",sans-serif"> evaluate procedure characteristics, safety, and feasibility of HBP and LBBP.</span></span></span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:black"><strong><span style="font-size:10.0pt"><span style="font-family:"Arial",sans-serif">Methods: </span></span></strong><span style="font-size:10.0pt"><span style="font-family:"Arial",sans-serif">Prospective, single-center study evaluating patients</span></span><span style="font-size:10.0pt"><span style="font-family:"Arial",sans-serif"> that had attempted HBP or LBBP from 07/2020 to 11/2021. Procedure details and pacing parameters were collected. </span></span></span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:black"><strong><span style="font-size:10.0pt"><span style="font-family:"Arial",sans-serif">Results:</span></span></strong> <span style="font-size:10.0pt"><span style="font-family:"Arial",sans-serif">During the inclusion period, 50 procedures of physiologic pacing were attempted in 46 patients. Acute procedural success was achieved in 96% of the cases (48/50 procedures [92.3% success for HBP and 100% success for LBBP]). Effective HBP was achieved in 24 procedures (8 selective HBP and 16 non-selective HBP) and effective LBBP in 24. </span></span><span style="font-size:10.0pt"><span style="font-family:"Arial",sans-serif">N</span></span><span style="font-size:10.0pt"><span style="font-family:"Arial",sans-serif">eed for reintervention during the enrolment period (either due to displacement or unsatisfactory threshold rise)</span></span><span style="font-size:10.0pt"><span style="font-family:"Arial",sans-serif"> occurred in 4 (8.3%) cases at a median time of 2.5 [1.3-3.8] months. </span></span><span style="font-size:10.0pt"><span style="font-family:"Arial",sans-serif">Median procedure duration was 93 [74-123] minutes and </span></span><span style="font-size:10.0pt"><span style="font-family:"Arial",sans-serif">median fluoroscopy time was 6:09 [3:27-11:07] minutes – no difference between HBP or LBBP </span></span><span style="font-size:10.0pt"><span style="font-family:"Arial",sans-serif">(P=0.36; P=0.15; respectively). Discharge thresholds were significantly lower in LBBP than in HBP while R wave amplitude was significantly higher in patients receiving LBBP, both at implantation and before discharge. No difference for paced QRS after HBP or LBBP were seen before discharge. Pacing parameters and comparisons between groups are shown in table 1. </span></span><span style="font-size:10.0pt"><span style="font-family:"Arial",sans-serif">There was no acute adverse event observed. </span></span><span style="font-size:10.0pt"><span style="font-family:"Arial",sans-serif">In the subgroup of patients with intraventricular conduction delay (QRS</span></span><span style="font-size:10.0pt"><span style="font-family:"Times New Roman",serif">≥</span></span><span style="font-size:10.0pt"><span style="font-family:"Arial",sans-serif"> 120ms, n=12), there was a reduction in the QRS duration after pacing (138±16 to 128±20ms). </span></span></span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:black"><strong><span style="font-size:10.0pt"><span style="font-family:"Arial",sans-serif">Conclusion: </span></span></strong><span style="font-size:10.0pt"><span style="font-family:"Arial",sans-serif">This study demonstrates the feasibility and safety of the physiologic pacing.</span></span></span></span></span></p>
Slides
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