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Contrast-enhanced image-guided lead deployment for left bundle branch pacing.

Xi Liu1, Hong-Xia Niu1, Min Gu1

  • 1Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.

Heart Rhythm
|April 22, 2021
PubMed
Summary

A new visualization technique significantly shortens procedure times and reduces lead repositioning for left bundle branch pacing (LBBP). This image-guided approach improves feasibility and efficiency for this novel conduction system pacing method.

Keywords:
Left bundle branch areaLeft bundle branch pacingSymptomatic bradycardiaTricuspid value annulusVisualization technique

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Area of Science:

  • Cardiology
  • Electrophysiology
  • Medical Devices

Background:

  • Left bundle branch pacing (LBBP) is an emerging conduction system pacing technique.
  • Lead deployment for LBBP can be technically challenging, impacting procedural efficiency.

Purpose of the Study:

  • To evaluate the feasibility of a visualization-enhanced technique for LBBP lead deployment.
  • To assess the impact of lead tip location on LBBP characteristics.
  • To compare an image-guided technique against the standard approach for LBBP implantation.

Main Methods:

  • A retrospective analysis of 20 patients informed an image-guided technique for identifying the LBBP target site.
  • A prospective randomized trial compared the image-guided (visualization) group (n=60) with a standard approach group.
  • Key metrics included procedural/fluoroscopic times, lead deployment attempts, and electrophysiological recordings.

Main Results:

  • Successful LBBP was achieved in comparable rates in both groups (28/60 standard vs. 29/60 visualization).
  • The visualization group demonstrated significantly shorter procedural (66.76 vs. 85.46 min) and fluoroscopic times (7.83 vs. 11.11 min) (P < .01).
  • Fewer lead deployment attempts (2.03 vs. 2.96; P < .01) and a higher rate of left bundle branch potential recording (79.3% vs. 46.4%; P = .01) were observed in the visualization group.

Conclusions:

  • A visualization-enhanced technique significantly shortens procedural and fluoroscopic durations for LBBP implantation.
  • This image-guided approach reduces the need for lead repositioning.
  • The technique improves the efficiency and success rate of left bundle branch pacing.