Physiologic lead placement with electroanatomic mapping: A case series.
Jayson R Baman1, Varun Garg2, Aravind G Kalluri3
1Department of Cardiology, Northwestern University, Chicago, Illinois, USA.
Journal of Cardiovascular Electrophysiology
|October 19, 2021
Summary
Three-dimensional electroanatomic mapping (EAM) guided His bundle pacing (HBP) and left bundle branch area pacing (LBBAP) show promise for cardiac resynchronization therapy in complex cases. This technique offers precise lead placement for improved outcomes.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Devices
Background:
- His bundle pacing (HBP) and left bundle branch area pacing (LBBAP) are emerging as alternatives to biventricular pacing for cardiac resynchronization therapy.
- Initial results with these techniques have been inconsistent, especially in patients with complex anatomy or prior failed lead implantations.
Purpose of the Study:
- To describe the utility of three-dimensional electroanatomic mapping (EAM) in guiding His bundle pacing (HBP) and left bundle branch area pacing (LBBAP) in challenging cases.
Main Methods:
- Five patients with complex cardiac anatomy or previous failed lead placements underwent EAM-guided HBP or LBBAP.
- Procedures were performed by experienced electrophysiologists using EAM in conjunction with intracardiac electrograms.
Main Results:
- Successful lead implantation was achieved in all five cases using EAM guidance.
- Low capture thresholds and evidence of successful lead function were observed during follow-up.
- Fluoroscopy time varied based on case complexity.
Conclusions:
- EAM enables targeted and precise lead placement for HBP and LBBAP.
- Further research is required to assess long-term efficacy and optimize patient selection for this approach.
