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Left bundle branch area pacing: the initial experience at a Portuguese tertiary center
Session:
Comunicações Orais - Sessão 16 - Pacing cardíaco
Speaker:
Daniel A. Gomes
Congress:
CPC 2024
Topic:
C. Arrhythmias and Device Therapy
Theme:
09. Device Therapy
Subtheme:
09.6 Device Therapy - Other
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Daniel A. Gomes; Mariana Sousa Paiva; Joana Certo Pereira; Francisco Moscoso Costa; Eduardo Varandas; Daniel Nascimento Matos; Gustavo Rodrigues; Pedro Galvão Santos; Pedro Carmo; Diogo Cavaco; Francisco Bello Morgado; Pedro Adragão
Abstract
<p style="text-align:justify"><span style="font-size:16px"><span style="font-family:Arial,Helvetica,sans-serif"><strong>Background:</strong></span></span></p> <p style="text-align:justify"><span style="font-size:16px"><span style="font-family:Arial,Helvetica,sans-serif">Left bundle branch area pacing (LBBAP) has gained significant recognition as an attractive alternative by preventing the deleterious effects of chronic right ventricular (RV) pacing, including desynchrony and LV dysfunction. Despite encouraging short-term results, reports of lead stability and outcomes on longer follow-ups are still scarce. We aimed to describe the procedure-related characteristics of LBBAP implantation, as well as the stability and electrical synchrony in the mid-term follow-up.</span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:16px"><span style="font-family:Arial,Helvetica,sans-serif"><strong>Methods:</strong></span></span></p> <p style="text-align:justify"><span style="font-size:16px"><span style="font-family:Arial,Helvetica,sans-serif">Single-center registry of patients undergoing LBBAP implantation since November 2021. The pacing lead was implanted deep on the interventricular septum, aiming for a right bundle branch pacing pattern and LV activation time (LVAT) < 90ms. Procedure-related characteristics as well as acute complications were assessed. Lead parameters and paced QRS duration (surrogate of electrical synchrony) were collected immediately after implantation and during follow-up.</span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:16px"><span style="font-family:Arial,Helvetica,sans-serif"><strong>Results:</strong></span></span></p> <p style="text-align:justify"><span style="font-size:16px"><span style="font-family:Arial,Helvetica,sans-serif">A total of 109 patients were included (mean age 77±10 years, 66% male, 29% with LV ejection fraction [LVEF] < 50%). The most common indications for ventricular pacing were high-degree atrioventricular block (n = 61, 56%) and biventricular CRT (BiV-CRT) bailout (n = 19, 17%). The mean implantation time was 63 (IQR 50-81) minutes, and fluoroscopy duration was 4 (IQR 3-7) minutes. LBBAP resulted in a median LV activation time (LVAT) of 87 (IQR 80-96) ms, and in all cases, an RBBB pattern in V1 was achieved. Final paced-QRS was significantly wider among those in whom LBBAP indication was CRT-bailout (130 [120-135] vs. 115 [IQR 106-123], p<0.001). This subgroup of patients had a higher incidence of LV dysfunction (LVEF 35±10% vs. 57±9%, p<0.001) and worse functional status (NYHA III/IV 42% vs. 16%, p=0.009). The last follow-up appointment was a median of 7 (IQR 2-10) months after implantation. Overall, QRS duration (124 [IQR 104-131] vs. 128 [IQR 120-140], Wilcoxon p=0.111) as well as lead parameters, including R-wave amplitude (12 [IQR 7-18] mV), pacing threshold (0.5 [0.5-0.75] V) and impedance (586 [IQR 475-700] Ohm), did not vary significantly. No cases of lead dislodgment, perforation, or significant pacing threshold rise leading to re-intervention were reported.</span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:16px"><span style="font-family:Arial,Helvetica,sans-serif"><strong>Conclusion:</strong></span></span></p> <p style="text-align:justify"><span style="font-size:16px"><span style="font-family:Arial,Helvetica,sans-serif">In our cohort, LBBAP implantation was feasible and safe, with favorable pacing parameters and lead stability during the mid-term follow-up. Even in CRT-bailout, LBBAP achieved relatively narrow QRS, supporting its role in this subset of patients.</span></span></p>
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