Procedure-Related Complications of Left Bundle Branch Pacing: A Single-Center Experience
Xueying Chen1, Lanfang Wei2, Jin Bai1
1Department of Cardiology, Zhongshan Hospital of Fudan University, Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, Shanghai, China.
Insights
Left bundle branch pacing (LBBP) is a safe pacing strategy with a low incidence of procedure-related complications, including septum perforation and lead dislodgement. Successful lead repositioning ensures no adverse clinical outcomes.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Devices
Background:
- Left bundle branch pacing (LBBP) offers a physiological pacing approach with promising low and stable thresholds.
- However, comprehensive safety data for LBBP, particularly regarding procedure-related complications, remains limited.
Purpose of the Study:
- To evaluate the incidence and types of procedure-related complications associated with LBBP.
- To assess the safety and clinical outcomes following management of these complications.
Main Methods:
- A retrospective analysis of 612 consecutive patients undergoing LBBP between January 2018 and July 2020.
- Inclusion of all patients experiencing procedure-related complications, with detailed data collection and analysis.
- Regular follow-up assessments at 1, 3, 6 months, and annually thereafter.
Main Results:
- A total of 10 complications (1.63%) were reported in 612 patients over a mean follow-up of 12.32 months.
- Specific complications included intraoperative septum injuries (0.65%), postoperative septum perforations (0.33%), intraoperative lead fractures (0.33%), and postoperative lead dislodgements (0.33%).
- Pacing parameters remained stable, and no major adverse events occurred after successful lead repositioning for perforation and dislodgement.
Conclusions:
- LBBP demonstrates a low incidence of procedure-related complications, such as septum injury/perforation and lead dislodgement/fracture.
- Management through lead repositioning and appropriate treatment leads to favorable clinical outcomes without significant adverse events.
Abstract:
Background: Although left bundle branch pacing (LBBP) has emerged as a novel physiological pacing strategy with a low and stable threshold, its safety has not been well-documented. In the present study, we included all the patients with procedure-related complications at our centre to estimate these LBBP cases with unique complications. Methods: We enrolled 612 consecutive patients who received the procedure in Zhongshan Hospital, Fudan University, between January 2018 and July 2020. Regular follow-ups were conducted (at 1, 3, and 6 months in the first year and every 6-12 months from the second year), and the clinical data of the patients with complications were collected and analyzed. Results: With a mean follow-up period of 12.32 ± 5.21 months, procedure-related complications were observed in 10 patients (1.63%) that included two postoperative septum perforations (2/612, 0.33%), two postoperative lead dislodgements (2/612, 0.33%), four intraoperative septum injuries (4/612, 0.65%), and two intraoperative lead fractures (2/612, 0.33%). Pacing parameters were stable during follow-up, and no major complications were observed after lead repositioning in the cases of septum perforation and lead dislodgement. Conclusion: The incidence of procedure-related complications for LBBP, namely postoperative septum perforation, postoperative lead dislodgement, intraoperative septum injury, and intraoperative lead fracture, were low. No adverse clinical outcomes were demonstrated after successful repositioning of the lead and appropriate treatment.
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