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Initial experience and medium-term results of Left Bundle Branch Area Pacing
Session:
Comunicações Orais - Sessão 16 - Pacing cardíaco
Speaker:
Diogo De Almeida Fernandes
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:
Diogo De Almeida Fernandes; João André Ferreira; Patrícia Alves; Carolina Saleiro; Natália António; Luís Elvas; Lino Gonçalves
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>INTRODUCTION</strong></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Right ventricular pacing (RV) and cardiac resynchronization therapy (CRT) have been the mainstay of pacing techniques for years. Left bundle branch area pacing (LBBAP) has arisen as an alternative, by maintaining left ventricular (LV) synchrony and potentially improving outcomes. Our aim was to describe LBBAP short and medium term results.</span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>METHODS</strong></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Single-center cohort study including consecutive patients who underwent LBBAP pacemaker implantation from Jan 2023 to Dec 2023. LBBAP ventricular lead was implanted using the tricuspid summit technique aided by pace mapping aiming for an LV activation time (LVAT) < 80 ms and/or V6–V1 inter-peak interval > 40ms. Procedural data, outcomes and lead parameters were recorded at 1 and 6 months follow-up.</span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>RESULTS</strong></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">A total of 139 patients underwent LBBAP, of which 85.6% with a stylet-driven lead. Mean age was 75.1 ± 10.1 years-old and 71.2% of patients were male. Most patients had sinus rhythm at implantation (72.7%) and 68.3% had a QRS greater than 120ms with an average length (± standard deviation) of 140 ± 34 ms. Complete atrioventricular (AV) block was the most common indication for pacemaker (42.4%) followed by 2<sup>nd</sup> degree AV block (24.5%) and heart failure with reduced LV ejection fraction (14.4%). 24.3% of patients had complete left bundle branch block. Mean procedural duration was 80 ± 23 min and mean fluoroscopy time was 13 ± 7 min. Average LVAT was 77 ± 8 ms and paced QRS of 113 ± 15 ms, resulting in a final QRS 27ms shorter than baseline. Acute R-wave amplitude was 12.3 mV (interquartile range [IQR] 7.2), pacing threshold was 0.5 V (IQR 0.2) and impedance 526 ? (IQR 219). No relevant per-operative complications occurred.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">After 1 month follow-up, median pacing threshold had significantly increased to 0.7 V (IQR 0.3; p < 0.001) while R-wave amplitude and impedance remained unchanged (p 0.609 and p 0.294 respectively). At 6 months of follow-up there were no changes on the evaluated parameters. During follow-up, loss of left bundle branch capture occurred in 10 patients (7.1%) and macro-dislodgement in 2 (1.4%).</span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>CONCLUSION</strong></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">LBBAP is a feasible and safe pacing technique which reduces QRS duration and improves LV synchrony. Furthermore, pacing parameters were stable after 6 months of follow-up and number of complications was low.</span></span></p>
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