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Left bundle branch pacing utilizing three dimensional mapping.

Pugazhendhi Vijayaraman1, Ragesh Panikkath1, Vernon Mascarenhas1

  • 1Geisinger Heart Institute, Geisinger Commonwealth School of Medicine, Wilkes-Barre, Pennsylvania.

Journal of Cardiovascular Electrophysiology
|October 19, 2019
PubMed
Summary
This summary is machine-generated.

Three-dimensional (3D) mapping aids left bundle branch area pacing (LBBP) implantation. This technique helps achieve successful LBBP in complex cases, potentially reducing the learning curve for new implanters.

Keywords:
3D mappingAV node ablationconduction system pacingleft bundle branch blockleft bundle branch pacing

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Area of Science:

  • Electrophysiology
  • Cardiovascular Interventions

Background:

  • Permanent His bundle pacing is effective but can have high capture thresholds.
  • Left bundle branch area pacing (LBBP) offers an alternative by pacing the left ventricular endocardium via the interventricular septum.

Observation:

  • Three-dimensional (3D) mapping systems were utilized to guide LBBP lead implantation.
  • The Ensite Precision mapping system created detailed 3D anatomical maps of the cardiac chambers.
  • Specific regions of interest, including potential LBBP sites, were identified and tagged on the 3D map.

Findings:

  • LBBP was successfully performed in three patients with challenging conditions: chronic left bundle branch block (LBBB), AV node ablation, and bifascicular block with severe left ventricular hypertrophy.
  • 3D mapping facilitated accurate assessment of lead depth within the interventricular septum, with measurements of 12, 11, and 21 mm.
  • The 3D map was instrumental in achieving successful lead placement and fixation.

Implications:

  • 3D mapping is a valuable tool for complex LBBP procedures, particularly in patients with LBBB, left ventricular hypertrophy, or following AV node ablation.
  • This technology can simplify lead implantation and improve lead depth assessment.
  • Utilizing 3D mapping may significantly reduce the learning curve for physicians new to LBBP procedures.