Fixation beats: A novel marker for reaching the left bundle branch area during deep septal lead implantation
Marek Jastrzębski1, Grzegorz Kiełbasa1, Paweł Moskal1
1First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University, Medical College, Krakow, Poland.
Insights
Monitoring for ectopic beats, termed "fixation beats," during left bundle branch (LBB) pacing lead implantation accurately predicts optimal septal depth. This simple method enhances procedural success and safety for LBB pacing.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Device Technology
Background:
- Left bundle branch (LBB) pacing aims for deep septal lead placement to engage the LBB area.
- Over-penetration risks lead perforation, while shallow placement compromises capture.
Purpose of the Study:
- To determine if "fixation beats" (ectopic beats with qR/rsR' morphology in lead V1) during lead fixation predict successful intraseptal lead depth.
- To establish fixation beats as a reliable intraprocedural indicator for LBB pacing lead placement.
Main Methods:
- Retrospective and prospective analysis of lead rotation events during LBB pacing implantations.
- Correlation of fixation beat occurrence with final lead position (LBB area vs. intermediate/unsuccessful).
Main Results:
- Fixation beats were highly predictive of reaching the LBB area (96.4% sensitivity, 97.3% specificity).
- In the prospective phase, fixation beats guided implantation, observed only at the correct LBB capture depth.
- P < .001 indicated a statistically significant association.
Conclusions:
- Monitoring fixation beats is a valuable tool for deep septal lead deployment in LBB pacing.
- This method can facilitate the procedure and enhance lead implantation safety.
Background:
One of the challenges of left bundle branch (LBB) pacing is placing the pacing lead deep enough in the septum to reach the LBB area, yet not too deep to avoid perforation.
Objective:
The purpose of this study was to investigate whether the occurrence of the ectopic beats with qR/rsR' morphology in lead V1 (fixation beats) during lead fixation would predict whether the desired intraseptal lead depth had been reached, whereas the lack of fixation beats would indicate a too-shallow position and the need for more lead rotations.
Methods:
Consecutive patients during LBB pacing device implantation were analyzed retrospectively and then prospectively with respect to the occurrence of fixation beats during each episode of lead rotation. We compared the presence of fixation beats during the lead rotation event directly before the LBB area depth was reached vs during the events before intermediate/unsuccessful positions.
Results:
A total of 339 patients and 1278 lead rotation events were analyzed. In the retrospective phase, fixation beats were observed in 327 of 339 final lead positions and in 9 of 939 intermediate lead positions (P <.001). Sensitivity, specificity, and positive and negative predictive values of the fixation beats as a marker for reaching the LBB area were 96.4%, 97.3%, 97.3%, and 96.5%, respectively. In the prospective, fixation beats-guided implantation phase, fixation beats were observed in all patients and only at the LBB capture depth.
Conclusion:
Monitoring fixation beats during deep septal lead deployment can facilitate the procedure and possibly increase the safety of lead implantation.
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