Background: Left bundle branch pacing(LBBP) provides physiological-activation with stable pacing parameters. However, there is paucity of data on direct assessment of lead-stability.
Objectives: Aim of study was to assess the stability of LBBP-lead using computed-tomographic-angiography(CTA) during medium-term follow-up and to correlate anatomical-location of the lead and electrophysiological characteristics of LBBP.
Methods: Consecutive patients with successful-LBBP using lumen-less lead were included. Patients without LBB-capture, contrast-allergy and renal-dysfunction were excluded. CTA was performed post-implantation and at 6-months. Primary end-point defined as consistent LBB-capture with helix tip separated from the LV blood-pool by <2mm by CTA at 6-months. Secondary end-points were defined as loss of conduction-system-capture(LOCSC) or perforation with complete capture-loss at 6-months.
Results: Overall, 67/105 patients who underwent CTA after successful LBBP were included. Mean follow-up 33.8±4.4 months. Non-selective to selective(NS-S) capture-transition was noted in 82%(n=55). Lead remined stable at 6-months with no difference in the mean-distance between LV blood-pool and helix-tip(-0.5±1.8mm vs -0.1±2.1mm;p=0.23). Primary end-point achieved in 89.5%(n=60). Consistent LBB capture(group-I) at 6-months was noted in 94%(n=63). LOCSC(group-II) was noted in 6%(n=4) at 6-months. No perforation into the LV cavity with complete loss of capture. Lead-displacement by >2mm away from the LV blood pool(sensitivity-100%;specificity-95%) and lack of NS-S capture-transition during implantation(odds ratio-18.0;95%CI 1.7-192.7;p=0.01) were the LOCSC predictors CONCLUSION: Deep septal deployment of the lead in the LV sub-endocardium for capture the LBB is safe with 94% of patients showing consistent conduction system capture during follow-up.
Keywords: Computed tomographic angiography; Left bundle branch pacing; helix tip; loss of conduction system capture; lumen-less lead.
Copyright © 2024. Published by Elsevier Inc.