SPC365

Left bundle branch area pacing using stylet-driven pacing leads- experience of one center

Session: Sessão de Posters 43 - Inovações em Síncope e Pacing Cardíaco
Speaker: Marta Catarina Bernardo

Congress: CPC 2024
Topic: C. Arrhythmias and Device Therapy
Theme: 09. Device Therapy
Subtheme: 09.6 Device Therapy - Other
Session Type: Cartazes
FP Number: ---
Authors: Marta Catarina Bernardo; Catarina Ribeiro Carvalho; José P. Guimarães; Sofia Silva Carvalho; Isabel Moreira; Luís Sousa Azevedo; Sílvia Leão; Renato Margato; José Paulo Fontes; Ilídio Moreira
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="color:#0e101a">Introduction: </span></strong><span style="color:#0e101a">Left bundle branch area pacing (LBBP) recently emerged as an alternative modality for conduction system pacing.&nbsp;</span></span></span><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:#0e101a">Most cases have been performed using a lumen-less pacing lead with a fixed helix design. However, </span>LBBP using stylet-driven pacing leads (SDL) with an extendable helix design emerged as a feasible alternative with comparable implant success.</span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="color:#0e101a">Aim: </span></strong><span style="color:#0e101a">To characterize the population of patients (pts) admitted for LBBP using SDL regarding i</span><span style="background-color:white"><span style="color:#212121">mplant success, complications, procedural and pacing characteristics at implant and during follow-up.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="color:#0e101a">Methods: </span></strong><span style="color:#0e101a">We performed a prospective observational study of consecutive pts submitted to LBBP using SDL in a single center between August 2022 and November 2023. We used the Solia S60 lead from Biotronik delivered through a preshaped sheath (Selectra 3D). The vascular access was the axillary/subclavian vein in all pts.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt"><span style="color:#0e101a">Results: </span></span></strong><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:#0e101a">LBBP was attempted in 53 pts and successful in 49 (92,5%). The mean age was 74 &plusmn;10 years and 62,3% were male. Baseline characteristics are shown in Table 1. The mean left ventricular ejection fraction (LVEF) was 54,83 &plusmn;10,0%, with 10 pts (20,8%) presenting with reduced LVEF (LVEF&lt;40% in 5 pts). The indication for pacing was atrioventricular (AV) block </span></span></span><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">in 34 pts (64,2%), sinus node dysfunction in 14 (26,4%), pacing and AV node ablation in 3 and heart failure in 2 (after failed cardiac resynchronization therapy). 15 pts had left bundle branch block in the basal electrocardiogram.</span></span> </span></span><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:#0e101a">Dual chamber pacemakers were implanted in 42 pts (79,2%). Pacing parameters at implantation were: R wave 8,97 &plusmn;5,33 mV, capture threshold 0,83 &plusmn;0,30V@ 0,5 ms and impedance 568,5 &plusmn;118,10 &Omega;. The mean fluoroscopy time was 10,92 &plusmn; 6,29 min. Mean LV activation time was 75,72 &plusmn; 10,08 and median paced QRS was 120 (IQR 120-130) ms. Failed implants resulted of failure to advance the SDL into the septum (2 pts) and lead dislodgment after sheath slitting (2 pts) after which it was decided to implant a conventional pacemaker.&nbsp;</span></span></span><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:#0e101a">Procedural complications included one local anaesthetic systemic toxicity, two damaged helix requiring new lead and one septal perforation (pt remained asymptomatic and the lead was repositioned).&nbsp;</span></span></span><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:#0e101a">1-month post-implantation the R wave increased </span>to 12,82 &plusmn; 6,75 mV (p&lt;0.01) and <span style="color:#0e101a">the capture threshold remained stable - 0,89 &plusmn; 0,84V@ 0,5 ms (p=0,45). The mean ventricular pacing percentage was 79,18 &plusmn; 27,69%. D</span></span></span><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:#0e101a">uring a median follow-up of 5,0 (IQR 2,0-7,5) months, we reported 1 case of a significant rise in threshold requiring lead revision. No other complications were observed.&nbsp;</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="color:#0e101a">Conclusions: </span></strong><span style="color:#0e101a">LBBP using SDL is a technique with high success rates, rare complications that provide low and stable pacing thresholds with reduced left ventricular activation time. This suggests physiological pacing that guarantees electrical synchrony of the left ventricle.&nbsp;We are awaiting the results of undergoing randomized clinical studies.</span></span></span></p>