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The learning curve of Left Bundle Branch Area Pacing: feasibility, safety and acute success rates - a single-center experience
Session:
Sessão de Posters 43 - Inovações em Síncope e Pacing Cardíaco
Speaker:
ANGELA MARGARIDA MARTINS DE CASTRO
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:
Margarida De Castro; Mariana Tinoco; Luísa Pinheiro; Cláudia Mendes; Assunção Alves; Bernardete Rodrigues; Olga Azevedo; Lucy Calvo; Sílvia Ribeiro; João Português; Victor Sanfins; António Lourenço
Abstract
<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:black">Introduction:</span></span></strong><span style="font-size:12.0pt"><span style="color:black"> Left bundle branch area (LBBA) pacing (LBBAP) is a physiological pacing modality that aims to avoid harmful effects of right ventricular pacing. </span></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:black">Aim: </span></span></strong><span style="font-size:12.0pt"><span style="color:black">We aimed to assess feasibility, safety, acute success and short-term stability of LBBAP in patients (pts) with conduction tissue and/or sinus node (SN) disease.</span></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:black">Methods:</span></span></strong><span style="font-size:12.0pt"><span style="color:black"> Retrospective study including pts that underwent LBBAP attempt from May 2022 to Nov 2023. ECG features, pacing and echocardiographic (echo) parameters and adverse events were evaluated during a mean follow-up (FU) of 9±5 months. </span></span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><span style="color:black">Successful LBBAP was defined as two of: paced QRS morphology of incomplete right bundle branch block (RBBB) pattern in V1, QRS<u><span style="color:teal"> </span></u>duration (QRSd) less than 130ms and/or left ventricle (LV) activation time (LVAT) less than 90ms. </span></span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><span style="color:black">In pts with echo evaluation after implantation, the inter-ventricular mechanical delay and the LV basal septal-to-lateral wall delay via tissue doppler imaging were analysed in order to assess mechanical desynchrony. </span></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:black">Results:</span></span></strong><span style="font-size:12.0pt"><span style="color:black"> We included 42 pts (69,0±10,8years; 57,1% males). Bundle branch block (BBB) was present in 55% (n=23), specifically left BBB (LBBB) in 28% (n=12). Mean QRSd was 118±30ms. LV ejection fraction was preserved in 88,1% of pts.</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><span style="color:black">Pacing indications are described in table 1. </span></span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><span style="color:black">LBBAP performed successfully in 88,1%(n=37) of pts with a median LVAT of 72,5±14,7ms. Lumenless pacing leads were used in 81%(n= 34) and stylet-driven in the remaining ones. </span></span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><span style="color:black">Reasons for failure were high pacing thresholds or inability to burrow lead into the septum for acceptable V1 morphology and LVAT.</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><span style="color:black">Mean procedure and fluoroscopy time were 86,5±24,3 and 9,0±5,9min. </span></span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><span style="color:black">Mean paced QRSd was 113,7±20,1ms during the procedure and 117,3±26,1ms at FU. In pts with baseline QRSd>110ms, the mean reduction of QRSd after LBBAP was 22,9±26,5ms. </span></span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><span style="color:black">One septal lead displacement occurred soon after the procedure. </span></span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><span style="color:black">Immediate and FU lead parameters were stable regarding ventricular threshold (0,54±0,11 <em>vs</em> 1,03±2,4, <em>p</em>=0,247) and sensing (11,34±6,9 <em>vs</em> 13,57±5,8, <em>p</em>=0,191). There was a decrease in ventricular lead impedance (566,83±128,02 vs 409,08±86,4, p=0,000). No complications were reported during FU.</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><span style="color:black">In pts who performed echo evaluation after LBBAP (n=17), 85% maintained interventricular and 100% intraventricular synchrony. </span></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:black">Conclusion:</span></span></strong><span style="font-size:12.0pt"><span style="color:black"> Our results showed that LBBAP yielded stable threshold, narrow QRSd and preserved LV synchrony with few minor complications. LBBAP holds promise as an attractive physiological pacing mode. </span></span></span></span></p>
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